CMS Price Transparency Data

Physical therapy (neuromuscular re-education)

Facility: Transylvania Regional Hospital, Inc

Billing Code: 97112 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97112
Insurance Median: $47
Cash Discount Price: $116
vs. Medicare Baseline: 1.44x Medicare

The contracted insurance negotiated median rate for a Physical therapy (neuromuscular re-education) at Transylvania Regional Hospital, Inc is $47. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $116. Compared to the federal Medicare reimbursement reference rate of $32.73, this hospital’s rate is 1.44x the Medicare baseline. Located in 90 Hospital Drive Po Box 1116, Brevard, NC.

Cash / Self-Pay

$116

Average discount available for prompt cash payment at this facility.

Insurance Median

$47

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: $116 (354%)

Insurance Median: $47 (144%)

Cash: $116 (354% of Medicare)

Ins. Median: $47 (144% 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
Blue Cross Blue Shield	$22 - $23	67%
United	$22 - $52	67%
Amerihealth	$23	70%
Apex Health	$23	70%
Partners Health Management	$23	70%
Vaya Health	$23	70%
Wellcare	$23	70%
Aetna	$30 - $84	92%
Cigna	$42 - $59	128%
Amerihealth Caritas	$47	144%
Caresource	$51	156%
Medcost	$65 - $98	199%
Magellan	$69	211%
Magellan Behavioral Health	$69	211%
Multiplan	$93	284%
Avalon Administrative Services	$98	299%
Prime Health	$102 - $104	312%

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 $116.
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 Transylvania Regional Hospital, Inc 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.