CMS Price Transparency Data

Physical therapy (neuromuscular re-education)

Facility: St Louis Childrens Hospital

Billing Code: 97112 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97112
Insurance Median: $165
Cash Discount Price: $139
vs. Medicare Baseline: 5.04x Medicare

The contracted insurance negotiated median rate for a Physical therapy (neuromuscular re-education) at St Louis Childrens Hospital is $165. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $139. Compared to the federal Medicare reimbursement reference rate of $32.73, this hospital’s rate is 5.04x the Medicare baseline. Located in One Childrens Place, Saint Louis, MO.

Cash / Self-Pay

$139

Average discount available for prompt cash payment at this facility.

Insurance Median

$165

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: $139 (425%)

Insurance Median: $165 (504%)

Cash: $139 (425% of Medicare)

Ins. Median: $165 (504% 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 504% of the Medicare baseline (a markup of 404%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Aetna	$31 - $182	95%
Blue Cross Blue Shield	$31 - $196	95%
Essence Healthcare [221]	$31	95%
Humana	$31 - $172	95%
UnitedHealthcare	$31 - $172	95%
Cox Health [757]	$33	101%
Medica [662]	$33	101%
Healthlink [225]	$112 - $174	342%
Cigna	$114 - $125	348%
Apwu Health Plan [216]	$125	382%
Consociate [478]	$125	382%
Nalc Health Benefit Plan [242]	$125	382%
Priority Health [648]	$125	382%
Sarah Bush Lincoln [636]	$125	382%
Cox Health Systems Insurance Company [220]	$127 - $171	388%
Allied Benefits [498]	$134 - $182	409%
Hope Trust [806]	$134	409%
Med-Pay [480]	$150 - $173	458%
Unicare [568]	$150 - $174	458%
Health Alliance [224]	$162	495%
Healthscope Benefits [258]	$165 - $185	504%
First Health Commercial [734]	$172	526%
Beechstreet [551]	$173	529%
Detego Health [868]	$173	529%
Health Systems Inc [620]	$173	529%
Healthcare Sol Mercy [609]	$173	529%
Multiplan Commercial [737]	$173	529%
Multiplan [240]	$173	529%
Phcs [244]	$173 - $185	529%
Preferred Health Professionals [561]	$174	532%
Coresource [497]	$182	556%
Fmh Benefit Service Inc [222]	$182	556%
Mail Handlers [495]	$182	556%
Medica [661]	$185	565%
Hfn [563]	$196	599%

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 $139.
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 St Louis Childrens Hospital 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.