CMS Price Transparency Data

Physical therapy (neuromuscular re-education)

Facility: Carilion Stonewall Jackson Hospital

Billing Code: 97112 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97112
Insurance Median: $112
Cash Discount Price: $61
vs. Medicare Baseline: 3.42x Medicare

The contracted insurance negotiated median rate for a Physical therapy (neuromuscular re-education) at Carilion Stonewall Jackson Hospital is $112. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $61. Compared to the federal Medicare reimbursement reference rate of $32.73, this hospital’s rate is 3.42x the Medicare baseline. Located in 1 Health Circle, Lexington, VA.

Cash / Self-Pay

$61

Average discount available for prompt cash payment at this facility.

Insurance Median

$112

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: $61 (186%)

Insurance Median: $112 (342%)

Cash: $61 (186% of Medicare)

Ins. Median: $112 (342% 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 342% of the Medicare baseline (a markup of 242%). 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	$34	104%
Sentara Health Plan	$34 - $108	104%
Abh of VA (Formerly Coventry)	$35	107%
Abh of Wva (Formerly Coventry)	$35	107%
Humana	$35	107%
UnitedHealthcare	$35 - $142	107%
Aetna	$89 - $116	272%
Gateway - Tier 3	$96	293%
Vhn - Ultra	$108	330%
Connecticare	$122	373%
Cigna	$139	425%
Gateway - Tier 2	$139	425%
Vhn - Plus	$139	425%
Integrated Health Plan	$148	452%
Vhn	$148	452%
Vhn - Link	$157	480%
Beech Street	$160	489%
Gateway - Tier 1	$165	504%
Vhn - Secondary Payors	$165	504%

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 $61.
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 Stonewall Jackson 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.