CMS Price Transparency Data

Physical therapy (neuromuscular re-education)

Facility: UT Health East Texas Athens Hospital

Billing Code: 97112 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97112
Insurance Median: $66
Cash Discount Price: $22
vs. Medicare Baseline: 2.02x Medicare

The contracted insurance negotiated median rate for a Physical therapy (neuromuscular re-education) at UT Health East Texas Athens Hospital is $66. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $22. Compared to the federal Medicare reimbursement reference rate of $32.73, this hospital’s rate is 2.02x the Medicare baseline. Located in 2000 South Palestine St, Athens, TX.

Cash / Self-Pay

$22

Average discount available for prompt cash payment at this facility.

Insurance Median

$66

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: $22 (67%)

Insurance Median: $66 (202%)

Cash: $22 (67% of Medicare)

Ins. Median: $66 (202% 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 202% of the Medicare baseline (a markup of 102%). 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
Medicaid / KanCare	$19 - $66	58%
Amerigroup Commercial [5055]	$54	165%
Black Lung [6055]	$54	165%
Healthcare Highways [2210]	$54	165%
Healthscope Benefits [2290]	$54	165%
Lucent Health [6000]	$54	165%
Web Tpa [2115]	$54 - $136	165%
Blue Cross Blue Shield	$66	202%
Cigna	$66 - $121	202%
Parkland Community Health Plan [6015]	$66	202%
UnitedHealthcare	$66	202%
Andrews Center Behavioral Health [3950]	$108	330%
Healthfirst [2395]	$108	330%
Aetna	$136	416%
Mailhandlers [1595]	$136	416%

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 $22.
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 UT Health East Texas Athens 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.