CMS Price Transparency Data

Physical therapy (neuromuscular re-education)

Facility: Mercy Hospital Ardmore, Inc

Billing Code: 97112 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97112
Insurance Median: $82
Cash Discount Price: $89
vs. Medicare Baseline: 2.51x Medicare

The contracted insurance negotiated median rate for a Physical therapy (neuromuscular re-education) at Mercy Hospital Ardmore, Inc is $82. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $89. Compared to the federal Medicare reimbursement reference rate of $32.73, this hospital’s rate is 2.51x the Medicare baseline. Located in 1011 14Th Ave Nw, Ardmore, OK.

Cash / Self-Pay

$89

Average discount available for prompt cash payment at this facility.

Insurance Median

$82

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: $89 (272%)

Insurance Median: $82 (251%)

Cash: $89 (272% of Medicare)

Ins. Median: $82 (251% 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 251% of the Medicare baseline (a markup of 151%). 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	$30 - $87	92%
Humana	$30 - $95	92%
Medicaid / KanCare	$30 - $42	92%
Blue Cross Blue Shield	$31	95%
Cherokee Nation Health Serv Contracted [320066]	$31	95%
Cross Timbers Hospice [20098]	$31	95%
Dept Of Veteran Affairs Contracted [320106]	$31	95%
Elara Caring Aspire Hospice Contracted [320433]	$31	95%
Elara Caring Aspire Hospice [20433]	$31	95%
Globalhealth Contracted [320145]	$31	95%
Halo Hcr Inc Hospice Contracted [320432]	$31	95%
Halo Hcr Inc Hospice [20432]	$31	95%
Independent Health [20197]	$31	95%
Indian Health Service Contracted [320198]	$31	95%
Kindful Hospice Contracted [320434]	$31	95%
Kindful Hospice [20434]	$31	95%
Medical Associates Health [20444]	$31	95%
Medicare (plans)	$31 - $137	95%
Mercy Hospice Okc [20252]	$31	95%
Provider Partners Health Plans Contracted [320450]	$31	95%
Qual Choice Contracted [320325]	$31	95%
Tribute Health Plan Mcr Contracted [320338]	$31	95%
Tricare	$31	95%
UnitedHealthcare	$31 - $112	95%
Cigna	$32 - $83	98%
Ambetter / Centene	$42	128%
Home State Health Plan Contracted [320187]	$42	128%
Novasys Contracted [320285]	$42	128%
Workers Comp [20426]	$43	131%
Community Care Contracted [320080]	$47 - $96	144%
Health Choice Contracted [320166]	$50	153%
Healthcare Highways Plus Contracted [320175]	$53 - $82	162%
Webtpa Contracted [320417]	$58	177%
Osma Health Contracted [320292]	$62	189%
Healthsmart Preferred Care Contracted [320184]	$69 - $89	211%
Kempton Contracted [320214]	$69	211%
Aither Health Contracted [320449]	$82	251%
Auxiant Contracted [320462]	$82 - $89	251%
Benefit Management Contracted [320052]	$82 - $89	251%
Ebms Contracted [320493]	$82	251%
Healthlink Contracted [320179]	$82 - $89	251%
Imagine 360 Contracted [320494]	$82	251%
Mercy Benefit Admin Contracted [320251]	$82 - $89	251%
Quik Trip Contracted [320447]	$82	251%
Reflect Health Contracted [320492]	$82	251%
Show-Me Health Administrators Contracted [320483]	$82	251%
Yuzu Health Contracted [320521]	$82	251%
Federal Medical Center Contracted [320127]	$89	272%
Healthscope Contracted [320182]	$89	272%
Healthsmart Accel Contracted [320183]	$89	272%
Point C Contracted [320238]	$89	272%
Preferred Health Plan Contracted [320522]	$89	272%
Tri State Healthcare Coalition Contracted [320379]	$89	272%
United Medical Resources Contracted [320454]	$89 - $112	272%
First Health Contracted [320128]	$91	278%
Globalhealth Contracted [320144]	$93	284%
Medica Contracted [320239]	$95 - $137	290%
Private Health Care Systems Contracted [320320]	$103 - $110	315%
Preferred Community Choice Contracted [320311]	$104	318%
Multiplan Contracted [320270]	$110 - $123	336%

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 $89.
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 Mercy Hospital Ardmore, 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.