CMS Price Transparency Data

Physical therapy (neuromuscular re-education)

Facility: Winter Haven Hospital

Billing Code: 97112 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97112
Insurance Median: $80
Cash Discount Price: $103
vs. Medicare Baseline: 2.44x Medicare

The contracted insurance negotiated median rate for a Physical therapy (neuromuscular re-education) at Winter Haven Hospital is $80. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $103. Compared to the federal Medicare reimbursement reference rate of $32.73, this hospital’s rate is 2.44x the Medicare baseline. Located in 200 Ave F Ne, Winter Haven, FL.

Cash / Self-Pay

$103

Average discount available for prompt cash payment at this facility.

Insurance Median

$80

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: $103 (315%)

Insurance Median: $80 (244%)

Cash: $103 (315% of Medicare)

Ins. Median: $80 (244% 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 244% of the Medicare baseline (a markup of 144%). 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
Clear Health Alliance	$22	67%
Freedom Health	$23	70%
Humana	$23 - $30	70%
Molina Healthcare	$23	70%
Simply Healthcare	$23 - $31	70%
Sunshine Health	$23	70%
UnitedHealthcare	$23 - $155	70%
Aetna	$24 - $140	73%
Baycareplus	$24	73%
Blue Cross Blue Shield	$24 - $99	73%
Florida Community Care	$24	73%
Solis Health	$26	79%
Cigna	$28 - $150	86%
Health First	$28	86%
Molina	$31 - $102	95%
Wellcare	$34	104%
Careplus	$37	113%
Freedom	$39	119%
Optimum	$39	119%
Ultimate Health Plan	$52	159%
Avmed	$53 - $84	162%
Ambetter / Centene	$54 - $172	165%
Florida Hospital	$79	241%
Evolutions	$86 - $160	263%
Multiplan	$138	422%
First Health	$146	446%
United Behavioral Health	$172	526%

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 $103.
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 Winter Haven 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.