Physical therapy (neuromuscular re-education)
Facility: Lmh
Billing Code: 97112 (CPT)
- CPT Billing Code: 97112
- Insurance Median: $32
- Cash Discount Price: $42
- vs. Medicare Baseline: 0.98x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| UnitedHealthcare | $27 - $166 | 82% |
| Blue Cross Blue Shield | $27 - $108 | 82% |
| Allwell | $28 - $32 | 86% |
| Aetna | $30 - $138 | 92% |
| Humana | $31 | 95% |
| Haskell Indian Health Services | $31 | 95% |
| Medicare (plans) | $31 | 95% |
| Cigna | $31 - $111 | 95% |
| Ambetter / Centene | $41 - $48 | 125% |
| Non Contracted | $133 | 406% |
| First Health | $155 | 474% |
Consumer Guidance & Cost Commentary
For this physical therapy service, the facility's cash price of $42.00 is significantly lower than the negotiated rates charged by most insurance plans, which range from $27 to $166 depending on the carrier. While the cash rate is higher than the Medicare benchmark of $32.73, it remains the most affordable option for patients without insurance or those with high-deductible plans where the insurance allowed amount might exceed the cash price. Patients should verify their specific plan's deductible status before assuming insurance will be cheaper, as some carriers may negotiate rates well above the cash price due to administrative costs and contract structures.
To ensure you are not overcharged, always request an itemized bill before paying, as summary invoices often hide unbundled codes or services not rendered. If you receive a balance bill from an out-of-network provider, remember that the No Surprises Act protects you from paying the difference between the provider's chargemaster and your insurance allowed amount for emergency care and non-emergency services at in-network facilities. Additionally, ask the hospital about prompt-pay discounts, which can reduce your final bill by 20% to 50% if you pay in full upfront, bypassing the costly claims processing that inflates insurance rates.