CMS Price Transparency Data

Physical therapy (neuromuscular re-education)

Facility: Atrium Health Pineville

Billing Code: 97112 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97112
Insurance Median: $72
Cash Discount Price: $90
vs. Medicare Baseline: 2.20x Medicare

The contracted insurance negotiated median rate for a Physical therapy (neuromuscular re-education) at Atrium Health Pineville is $72. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $90. Compared to the federal Medicare reimbursement reference rate of $32.73, this hospital’s rate is 2.20x the Medicare baseline. Located in 10628 Park Rd, Charlotte, NC.

Cash / Self-Pay

$90

Average discount available for prompt cash payment at this facility.

Insurance Median

$72

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: $90 (275%)

Insurance Median: $72 (220%)

Cash: $90 (275% of Medicare)

Ins. Median: $72 (220% 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 220% of the Medicare baseline (a markup of 120%). 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
Alliance	$18 - $24	55%
Amerihealth Caritas	$18 - $24	55%
Partners	$18 - $24	55%
Carolina Complete Health	$19 - $24	58%
Healthy Blue	$19 - $24	58%
Trillium	$19 - $23	58%
Vaya	$19 - $24	58%
Wellcare	$19 - $24	58%
UnitedHealthcare	$24 - $85	73%
Cigna	$31 - $121	95%
Humana	$31	95%
Aetna	$32 - $149	98%
Ortho Carolina	$38	116%
Blue Cross Blue Shield	$49 - $70	150%
Ambetter / Centene	$52 - $65	159%
Employers Health Network	$79	241%
Physician Reach Out	$90	275%
Medcost	$97 - $107	296%
Magellan	$108	330%
Gmmi	$117	357%
Quik Trip	$117	357%
Choicecare	$129 - $133	394%
Healthgram	$144	440%
Provider Select	$145 - $162	443%
Private Health Care Systems	$147	449%
First Health	$149	455%
Beechstreet	$162	495%
Multiplan	$165	504%

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 $90.
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 Atrium Health Pineville 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.