CMS Price Transparency Data

Physical therapy (neuromuscular re-education)

Facility: Nationwide Children's Hospital Toledo, LLC

Billing Code: 97112 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97112
Insurance Median: $96
Cash Discount Price: $158
vs. Medicare Baseline: 2.93x Medicare

The contracted insurance negotiated median rate for a Physical therapy (neuromuscular re-education) at Nationwide Children's Hospital Toledo, LLC is $96. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $158. Compared to the federal Medicare reimbursement reference rate of $32.73, this hospital’s rate is 2.93x the Medicare baseline. Located in 2213 Cherry Street, Toledo, OH.

Cash / Self-Pay

$158

Average discount available for prompt cash payment at this facility.

Insurance Median

$96

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: $158 (483%)

Insurance Median: $96 (293%)

Cash: $158 (483% of Medicare)

Ins. Median: $96 (293% 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 293% of the Medicare baseline (a markup of 193%). 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	$27 - $134	82%
Tricare	$29	89%
Caresource	$31 - $44	95%
Paramount	$31	95%
Front Path Health Coalition	$41 - $118	125%
Molina	$42 - $96	128%
Mcclaren Health Plan - Michigan	$43	131%
Mcclaren Health Plan	$44 - $118	134%
Aetna	$47 - $101	144%
Mmo	$61 - $92	186%
Cigna	$86	263%
UnitedHealthcare	$96 - $133	293%
Amerihealth	$97	296%
Bchp	$97	296%
Humana	$97	296%
Ohc	$132 - $184	403%
Ohio Ppo Connect	$132 - $184	403%
First Health	$203	620%

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 $158.
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 Nationwide Children's Hospital Toledo, LLC 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.