CMS Price Transparency Data

Physical therapy (neuromuscular re-education)

Facility: Children's Hospital Colorado

Billing Code: 97112 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97112
Insurance Median: $89
Cash Discount Price: $88
vs. Medicare Baseline: 2.72x Medicare

The contracted insurance negotiated median rate for a Physical therapy (neuromuscular re-education) at Children's Hospital Colorado is $89. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $88. Compared to the federal Medicare reimbursement reference rate of $32.73, this hospital’s rate is 2.72x the Medicare baseline. Located in 13123 E 16Th Ave, Aurora, CO.

Cash / Self-Pay

$88

Average discount available for prompt cash payment at this facility.

Insurance Median

$89

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: $88 (269%)

Insurance Median: $89 (272%)

Cash: $88 (269% of Medicare)

Ins. Median: $89 (272% 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 272% of the Medicare baseline (a markup of 172%). 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
Ccha Behavioral Health	$14	43%
Integrated Health Plan	$20	61%
Kaiser	$46 - $99	141%
Denver Health Medical Plan	$47 - $102	144%
Rocky Mountain Health Plan Behavioral Health	$54	165%
Carelon Behavioral Health	$61 - $95	186%
Presbyterian Health Plan	$65 - $78	199%
Colorado Access	$67	205%
Colorado Access Behavioral Health	$67	205%
Molina Healthcare Of Nebraska	$75	229%
Molina Healthcare Of New Mexico	$75	229%
Peak Health Alliance/Ebms	$75 - $82	229%
Rocky Mountain Health Plan	$75 - $88	229%
Healthy Blue Of Nebraska	$79	241%
Blue Cross Blue Shield	$80 - $102	244%
Humana	$83 - $95	254%
UnitedHealthcare	$85 - $91	260%
Evernorth Behavioral Health	$88	269%
Interlink National	$88 - $102	269%
Centivo	$94	287%
Select Health	$95	290%
Uchealth Plan Administrators	$95	290%
Cigna	$98	299%
Aetna	$99 - $109	302%
Department Of Corrections	$106	324%
Comppsych Behavioral Health	$116	354%
First Choice Health	$116	354%
Midlands Choice	$116	354%
National Preferred Provider Network	$116	354%
Multiplan	$117	357%
Cofinity	$122	373%
First Choice Of The Midwest	$122	373%
Usa Managed Care Organization	$122	373%
First Health Network	$125	382%

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 $88.
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 Children's Hospital Colorado 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.