CMS Price Transparency Data

Physical therapy (neuromuscular re-education)

Facility: Tri Valley Health System

Billing Code: 97112 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97112
Insurance Median: $111
Cash Discount Price: $148
vs. Medicare Baseline: 3.39x Medicare

The contracted insurance negotiated median rate for a Physical therapy (neuromuscular re-education) at Tri Valley Health System is $111. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $148. Compared to the federal Medicare reimbursement reference rate of $32.73, this hospital’s rate is 3.39x the Medicare baseline. Located in 1305 West Highway 6/34, Cambridge, NE.

Cash / Self-Pay

$148

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: $148 (452%)

Insurance Median: $111 (339%)

Cash: $148 (452% 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.

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
Blue Cross Blue Shield	$66 - $168	202%
Humana	$66 - $78	202%
Medica Mcr Adv	$66 - $78	202%
Medica Prime Sol	$66 - $78	202%
Tricare	$66 - $78	202%
Wellcare Mcr Adv - All Plans	$66 - $78	202%
Great Plains Mcr Adv - All Plans	$70 - $82	214%
Healthy Blue Mcaid - All Plans	$72 - $85	220%
Molina Mcaid - All Plans	$72 - $85	220%
Nebraska Total Care-All Plans	$72 - $85	220%
UnitedHealthcare	$72 - $170	220%
Amerigroup Mcaid - All Plans	$74 - $87	226%
Medica Chi Aco - All Other Plans	$136 - $159	416%
Medica Chi Open Access	$136 - $159	416%
Medica Ifb Aco	$136 - $159	416%
Medica Ifb Open Access	$136 - $159	416%
Midlands Choice-All Plans	$136 - $159	416%
Aetna	$148 - $173	452%
Multiplan-All Plans	$148 - $173	452%

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 $148.
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 Tri Valley Health System 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.