CMS Price Transparency Data

Physical therapy (neuromuscular re-education)

Facility: Gunnison Valley Hospital

Billing Code: 97112 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97112
Insurance Median: $104
Cash Discount Price: $104
vs. Medicare Baseline: 3.18x Medicare

The contracted insurance negotiated median rate for a Physical therapy (neuromuscular re-education) at Gunnison Valley Hospital is $104. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $104. Compared to the federal Medicare reimbursement reference rate of $32.73, this hospital’s rate is 3.18x the Medicare baseline. Located in 711 N Taylor St, Gunnison, CO.

Cash / Self-Pay

$104

Average discount available for prompt cash payment at this facility.

Insurance Median

$104

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: $104 (318%)

Insurance Median: $104 (318%)

Cash: $104 (318% of Medicare)

Ins. Median: $104 (318% 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 318% of the Medicare baseline (a markup of 218%). 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	$48	147%
Medicare (plans)	$60	183%
Gunnison County Coroner Op Only	$63	192%
Gunnison County Sheriff Op & Profee Only	$63	192%
Ebms Hdhp	$73 - $74	223%
Tetwp Op & Profee Only-All Plans	$73 - $74	223%
U Of Co Transplant-All Plans	$73 - $74	223%
Ebms Ppo Plan-All Other Plans	$85 - $86	260%
Gunnison County Employees-All Other Plans	$98	299%
Scottish Rites-All Plans	$98	299%
Elap Employers-All Plans	$104	318%
Blue Cross Blue Shield	$107 - $108	327%
Apostrophe-All Plans	$110	336%
Multiplan-All Plans	$113 - $114	345%
Rocky Mountain Health-All Plans	$116 - $117	354%
UnitedHealthcare	$116 - $117	354%
Aetna	$117 - $118	357%
Cofinity-All Plans	$117 - $118	357%
Cigna	$120	367%

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 $104.
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 Gunnison Valley 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.