CMS Price Transparency Data

Physical therapy (neuromuscular re-education)

Facility: Carilion Tazewell Community Hospital

Billing Code: 97112 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97112
Insurance Median: $136
Cash Discount Price: $76
vs. Medicare Baseline: 4.16x Medicare

The contracted insurance negotiated median rate for a Physical therapy (neuromuscular re-education) at Carilion Tazewell Community Hospital is $136. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $76. Compared to the federal Medicare reimbursement reference rate of $32.73, this hospital’s rate is 4.16x the Medicare baseline. Located in 388 Ben Bolt Avenue, Tazewell, VA.

Cash / Self-Pay

$76

Average discount available for prompt cash payment at this facility.

Insurance Median

$136

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: $76 (232%)

Insurance Median: $136 (416%)

Cash: $76 (232% of Medicare)

Ins. Median: $136 (416% 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 416% of the Medicare baseline (a markup of 316%). 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
Corvel	$30	92%
Blue Cross Blue Shield	$34	104%
Sentara Health Plan	$34 - $135	104%
Abh Of Va (Formerly Coventry)	$35	107%
Abh Of Wva (Formerly Coventry)	$35	107%
Humana	$35	107%
UnitedHealthcare	$35 - $177	107%
Aetna	$110 - $144	336%
Gateway - Tier 3	$119	364%
Vhn - Ultra	$135	412%
Cigna	$138 - $147	422%
Connecticare	$152	464%
Vhn - Plus	$167	510%
Gateway - Tier 2	$174	532%
Vhn	$174	532%
Integrated Health Plan	$184	562%
Vhn - Link	$195	596%
Gateway - Tier 1	$206	629%
Vhn - Secondary Payors	$206	629%
National Provider Network	$208	636%

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 $76.
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 Carilion Tazewell Community 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.