CMS Price Transparency Data
Physical therapy (neuromuscular re-education)
Facility: Mercy Health Lakeshore Campus
Billing Code: 97112 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 97112
- Insurance Median: $111
- Cash Discount Price: $84
- vs. Medicare Baseline: 3.39x Medicare
The contracted insurance negotiated median rate for a Physical therapy (neuromuscular re-education) at Mercy Health Lakeshore Campus is $111. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $84. Compared to the federal Medicare reimbursement reference rate of $32.73, this hospital’s rate is 3.39x the Medicare baseline. Located in 72 South State Street, Shelby, MI.
Cash / Self-Pay
$84
Average discount available for prompt cash payment at this facility.
Insurance Median
$111
Median negotiated contract rate across all mapped commercial carriers.
Medicare Reference Rate
$32.73
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. Medicare
Medicare Reference Baseline: $32.73 (100%)
Cash / Self-Pay: $84 (257%)
Insurance Median: $111 (339%)
Cash: $84 (257% of Medicare)
Ins. Median: $111 (339% of Medicare)
Understanding this gauge: We use the federal Medicare rate of $32.73 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.
Elevated Commercial Rate Alert (Value-Gap)
The negotiated rate at this facility is 339% of the Medicare baseline (a markup of 239%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
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Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Access Health | $23 | 70% |
| Blue Cross Blue Shield | $23 - $110 | 70% |
| Medicaid / KanCare | $23 - $24 | 70% |
| Aetna | $32 - $103 | 98% |
| Blue Care Network Advantage | $32 | 98% |
| Medicare (plans) | $32 | 98% |
| Oscar | $40 | 122% |
| UnitedHealthcare | $45 - $116 | 137% |
| U Of M Health Plan | $49 - $115 | 150% |
| Wellpath | $49 | 150% |
| Molina Marketplace | $54 | 165% |
| Hospice Of Michigan | $71 | 217% |
| Nomi Health | $72 | 220% |
| Hap | $97 - $118 | 296% |
| Wc Accident Fund | $102 | 312% |
| Wc Advantage | $102 | 312% |
| Wc Aig | $102 | 312% |
| Wc Allied | $102 | 312% |
| Wc Amerisure | $102 | 312% |
| Wc Amtrust | $102 | 312% |
| Wc Asu Risk Mgt | $102 | 312% |
| Wc Berkley Admin | $102 | 312% |
| Wc Broadspire | $102 | 312% |
| Wc Bunch & Associates | $102 | 312% |
| Wc Ccmsi | $102 | 312% |
| Wc Emc Insurance Company | $102 | 312% |
| Wc Esis | $102 | 312% |
| Wc Fcci | $102 | 312% |
| Wc Federated | $102 | 312% |
| Wc Gallagher Bassett | $102 | 312% |
| Wc Genex Care For Ohio | $102 | 312% |
| Wc Guard Insurance Company | $102 | 312% |
| Wc Hartford | $102 | 312% |
| Wc Liberty Mutual | $102 | 312% |
| Wc Meijers | $102 | 312% |
| Wc Michigan | $102 | 312% |
| Wc Mitchell Frankenmuth | $102 | 312% |
| Wc Pma | $102 | 312% |
| Wc Sedgwick | $102 | 312% |
| Wc Sentry | $102 | 312% |
| Wc Travelers | $102 | 312% |
| Wc Tristar | $102 | 312% |
| Wc Walmart | $102 | 312% |
| Wc Zurich | $102 | 312% |
| Geha | $103 - $116 | 315% |
| Meritain | $103 | 315% |
| Asr Health Benefits | $107 | 327% |
| Bcn Domestic | $110 | 336% |
| Blue Benefit Administrators Of Massachusetts | $110 | 336% |
| Blue Care Network | $110 | 336% |
| Blue Distinction Transplant | $110 | 336% |
| Blue Shield - Ca | $110 | 336% |
| Blue Shield - Id (Regence) | $110 | 336% |
| Blue Shield - Ny Highmark Northeastern | $110 | 336% |
| Blue Shield - Ny Highmark Western | $110 | 336% |
| Blue Shield - Pa (Highmark) | $110 | 336% |
| Blue Shield - Wa (Regence) | $110 | 336% |
| Health Choices | $110 - $115 | 336% |
| Kaiser Domestic | $110 | 336% |
| 1199 National Benefit Fund | $111 | 339% |
| Allied National Global Care | $111 | 339% |
| Asrm - Reliance Standard Life Insurance | $111 | 339% |
| Christian Care Ministry | $111 | 339% |
| Dean Health | $111 | 339% |
| Fallon Health | $111 | 339% |
| Family Life Insurance Company | $111 | 339% |
| Ghc Scw | $111 | 339% |
| Group Pension Administrators | $111 | 339% |
| International Benefit Administrators | $111 | 339% |
| Lifetime Benefit Solutions | $111 | 339% |
| Manhattan Life | $111 | 339% |
| Medi Share | $111 | 339% |
| Multiplan | $111 | 339% |
| Mvp | $111 | 339% |
| Pai | $111 | 339% |
| Pan-American Life | $111 | 339% |
| Paramount Hmo | $111 | 339% |
| Phcs | $111 | 339% |
| Trinity Health Share | $111 | 339% |
| Cigna | $112 | 342% |
| Acclaim | $115 | 351% |
| Administrative Concepts | $115 | 351% |
| Allegeant | $115 | 351% |
| Allied Benefit Systems | $115 | 351% |
| Ameriben | $115 | 351% |
| American Family | $115 | 351% |
| American Healthcare Alliance | $115 | 351% |
| American Republic | $115 | 351% |
| Amerihealth | $115 | 351% |
| Aultcare | $115 | 351% |
| Automated Benefit Services | $115 | 351% |
| Auxiant | $115 | 351% |
| Benefit Administrative Systems,Llc | $115 | 351% |
| Boon Chapman | $115 | 351% |
| Cam Administrative Services | $115 | 351% |
| Caresource | $115 | 351% |
| Christian Brother Services | $115 | 351% |
| Christian Brothers Holy Cross | $115 | 351% |
| Claimchoice Adminstrators | $115 | 351% |
| Comprehensive Benefits | $115 | 351% |
| Consociate | $115 | 351% |
| Continental Life Insurance | $115 | 351% |
| Custom Benefit Administrators | $115 | 351% |
| Cypress Benefit Administrators | $115 | 351% |
| Employee Benefit Concepts | $115 | 351% |
| Employee Benefit Management | $115 | 351% |
| Enterprise Group Planning | $115 | 351% |
| Forest County Potawatomi | $115 | 351% |
| Freedom Life Insurance Company | $115 | 351% |
| Group Administrators | $115 | 351% |
| Group Marketing Services | $115 | 351% |
| Guardian | $115 | 351% |
| Health America | $115 | 351% |
| Health Smart | $115 | 351% |
| Healthez | $115 | 351% |
| Healthgram | $115 | 351% |
| Healthscope | $115 | 351% |
| Humana | $115 | 351% |
| Insight | $115 | 351% |
| Intercare | $115 | 351% |
| Jfp Benefit Management | $115 | 351% |
| Jp Farley Corporation | $115 | 351% |
| Key Benefit Administrator | $115 | 351% |
| Liberty Union Life Assurance Co | $115 | 351% |
| Lucent Health | $115 | 351% |
| Luminare Health | $115 | 351% |
| Luminare Health (Detroit) | $115 | 351% |
| Medben | $115 | 351% |
| Medcost | $115 | 351% |
| Medical Mutual | $115 | 351% |
| Mutual Health Services | $115 | 351% |
| Mutual Of Omaha | $115 | 351% |
| Ncas | $115 | 351% |
| Nippon Life Ins | $115 | 351% |
| Nova | $115 | 351% |
| Painters Union Insurance Fund | $115 | 351% |
| Physicians Mutual | $115 | 351% |
| Plumbers Local 98 Insurance Fund | $115 | 351% |
| Prairie States | $115 | 351% |
| Primary Physician Care | $115 | 351% |
| Professional Benefit Administrators | $115 | 351% |
| Secureone Preferred United Plans | $115 | 351% |
| The Loomis Company | $115 | 351% |
| Trustmark Small Business Benefits | $115 | 351% |
| Unicare | $115 | 351% |
| Unified Group Services | $115 | 351% |
| Us Health And Life | $115 | 351% |
| Valenz | $115 | 351% |
| Varipro | $115 - $118 | 351% |
| Western & Southern Financial Group | $115 | 351% |
| Wps | $115 | 351% |
| Priority Health | $116 | 354% |
| First Health | $117 | 357% |