CMS Price Transparency Data

Physical therapy (neuromuscular re-education)

Facility: South Pointe Hospital

Billing Code: 97112 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97112
Insurance Median: $111
Cash Discount Price: $157
vs. Medicare Baseline: 3.39x Medicare

The contracted insurance negotiated median rate for a Physical therapy (neuromuscular re-education) at South Pointe Hospital is $111. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $157. Compared to the federal Medicare reimbursement reference rate of $32.73, this hospital’s rate is 3.39x the Medicare baseline. Located in 20000 Harvard Road, Warrensville Heights, OH.

Cash / Self-Pay

$157

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: $157 (480%)

Insurance Median: $111 (339%)

Cash: $157 (480% 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
Aetna	$41 - $242	125%
Humana	$41 - $206	125%
Summacare	$41 - $91	125%
The Health Plan	$41 - $145	125%
UnitedHealthcare	$41 - $150	125%
Upmc	$41 - $145	125%
Valor	$41	125%
Cigna	$42 - $194	128%
United	$42 - $238	128%
Perennial Health	$45	137%
Oscar	$73 - $93	223%
Paramount	$83	254%
Blue Cross Blue Shield	$85 - $157	260%
Buckeye	$85	260%
Molina	$85	260%
Caresource	$86	263%
Amerihealth	$89	272%
Cc Ehp	$97 - $98	296%
Aultcare	$104	318%
Ohcp	$118	361%
Omas	$121	370%
Mmo	$130 - $145	397%
Ohio Healthy	$131	400%
Healthsmart	$133	406%
Php	$145	443%
Gms	$169	516%
Medical Benefit Corp	$169	516%
Quality Care Partners	$169	516%
Consociate Health	$182	556%
Frontpath	$218	666%
Managed Care Services	$218	666%
Multiplan	$218	666%
Tertiary Care Network	$218	666%
Three Rivers	$218	666%

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 $157.
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 South Pointe 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.