CMS Price Transparency Data

Physical therapy (neuromuscular re-education)

Facility: St Mary Medical Center

Billing Code: 97112 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 97112
  • Insurance Median: $61
  • Cash Discount Price: $130
  • vs. Medicare Baseline: 1.86x Medicare
The contracted insurance negotiated median rate for a Physical therapy (neuromuscular re-education) at St Mary Medical Center is $61. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $130. Compared to the federal Medicare reimbursement reference rate of $32.73, this hospital’s rate is 1.86x the Medicare baseline. Located in Langhorne-Newtown Rd, Langhorne, PA.
Cash / Self-Pay
$130

Average discount available for prompt cash payment at this facility.

Insurance Median
$61

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: $130 (397%)
Insurance Median: $61 (186%)
Cash: $130 (397% of Medicare)
Ins. Median: $61 (186% 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.

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
Medicaid / KanCare $19 - $40 58%
Aetna $24 - $178 73%
Pace-Trinity Health $26 79%
UnitedHealthcare $28 - $106 86%
Blue Cross Blue Shield $34 - $74 104%
Cigna $34 - $358 104%
Align Senior Care $35 107%
Medicare (plans) $35 - $61 107%
Keystone First $40 122%
Keystone First Chip $40 122%
Health America Advantra $41 125%
Ambetter / Centene $61 186%
Oscar $61 186%
Prime Healthcare $61 186%
Jefferson Health Plan Commercial $62 189%
Homestead Health Plans Woods Center $66 202%
Amerihealth $74 226%
Blue Shield - Ca $74 226%
Blue Shield - Id (Regence) $74 226%
Blue Shield - Ny Highmark Western $74 226%
Blue Shield - Wa (Regence) $74 226%
Group Pension Administrators $76 232%
Reedman Toll $76 232%
Blue Shield - Pa (Highmark) $92 281%
Geha $106 324%
Meritain $178 544%
Multiplan $180 550%
Prime Health Services $180 550%
Galaxy Health Network $190 581%
Three Rivers Provider Network $190 581%
Upmc Health Plan $358 1094%
Webtpa $358 1094%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: Langhorne-Newtown Rd, Langhorne, PA 19047
  • CMS Rating: ★★☆☆☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals