CMS Price Transparency Data

Physical therapy (neuromuscular re-education)

Facility: Essentia Health St Mary's Medical Center

Billing Code: 97112 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97112
Insurance Median: $49
Cash Discount Price: $65
vs. Medicare Baseline: 1.50x Medicare

The contracted insurance negotiated median rate for a Physical therapy (neuromuscular re-education) at Essentia Health St Mary's Medical Center is $49. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $65. Compared to the federal Medicare reimbursement reference rate of $32.73, this hospital’s rate is 1.50x the Medicare baseline. Located in 402 East Second Street, Duluth, MN.

Cash / Self-Pay

$65

Average discount available for prompt cash payment at this facility.

Insurance Median

$49

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: $65 (199%)

Insurance Median: $49 (150%)

Cash: $65 (199% of Medicare)

Ins. Median: $49 (150% 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.

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Advocare/Security Health	$32	98%
Blue Cross Blue Shield	$32 - $74	98%
Freedom Blue Ppo	$32	98%
Healthpartners Care Msho / Mcr Adv	$32	98%
Imcare Msho (Ref Req)	$32	98%
Imcare Msho Pcc Prime	$32	98%
Imcare Msho Ref Req	$32	98%
Itasca Med Care	$32	98%
Medica Access	$32	98%
Medica Advantage Solutions	$32	98%
Medica Msho/Dual Solutions	$32	98%
Medica Prime Solution Group	$32	98%
Medicare (plans)	$32	98%
Nd Va Administration	$32	98%
Platinum Blue / Vantage Blue	$32	98%
Primewest Msho	$32	98%
Secure Blue Msho	$32	98%
Ubh Cost Plan	$32	98%
Ubh Msho	$32	98%
Ucare Msho	$32	98%
UnitedHealthcare	$32 - $72	98%
Primewest	$34	104%
Healthpartners Care Pmap	$39	119%
Sanford Health Plan	$42 - $67	128%
Blue Plus Pmap Pcc Prime	$43 - $49	131%
Medica	$54 - $56	165%
Medica Uplan	$54	165%
Healthpartners	$59 - $70	180%
Medica Choice	$60	183%
Ucare	$64	196%
Cigna	$70	214%
Healthpartners Pcc Prime	$70	214%
Wea	$71 - $75	217%
Security Health	$75	229%
America'S Ppo	$76	232%
Wps	$81 - $82	247%
Aetna	$83	254%
Healthscope Benefits	$83	254%
Healtheos	$84	257%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $65.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 97112.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Essentia Health St Mary's Medical Center is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 97112.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.