CMS Price Transparency Data

Physical therapy (neuromuscular re-education)

Facility: Adventist Health Delano

Billing Code: 97112 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97112
Insurance Median: $52
Cash Discount Price: $18
vs. Medicare Baseline: 1.59x Medicare

The contracted insurance negotiated median rate for a Physical therapy (neuromuscular re-education) at Adventist Health Delano is $52. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $18. Compared to the federal Medicare reimbursement reference rate of $32.73, this hospital’s rate is 1.59x the Medicare baseline. Located in 1401 Garces Highway, Delano, CA.

Cash / Self-Pay

$18

Average discount available for prompt cash payment at this facility.

Insurance Median

$52

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: $18 (55%)

Insurance Median: $52 (159%)

Cash: $18 (55% of Medicare)

Ins. Median: $52 (159% 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.

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
Dignty Hlth Mcal Op Only	$18	55%
Kaiser Medi-Cal Ip/Op Only	$18	55%
Medi-Cal	$18	55%
Universal Care Mcal	$18	55%
Blue Cross Blue Shield	$20 - $77	61%
Blue Shield Epn - All Other Plans	$20	61%
Healthnet Medi-Cal	$21	64%
Kern Health System Mcal	$23	70%
Bakersfield Fam Med Grp-All Plans	$34	104%
Healthnet Mcr Adv	$34	104%
Kern Mcr Adv Dual Dnsp-All Other Plans	$34	104%
Medicare (plans)	$34 - $55	104%
Tricare	$34	104%
UnitedHealthcare	$34 - $66	104%
Universal Care Mcr- All Other Plans	$34	104%
Healthnet- All Other Plans	$49	150%
Coventry- All Plans	$55	168%
Kaiser Comm Ip/Op Only- All Other Plans	$59	180%
Ah Employee Health Plan - All Plans	$62	189%
County Of Kern Network - All Plans	$64	196%
Gem Care- All Plans	$64	196%
Aetna	$68	208%
Foundation For Medical Care Of Kern County - All P	$69	211%
Cigna	$74	226%
Western Growers - All Plans	$75	229%
Centivo - All Plans	$77	235%
Blue Shield Non-Epn	$262	800%

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 $18.
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 Adventist Health Delano 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.