Physical therapy (neuromuscular re-education)
Facility: Mercy Hospital Columbus
Billing Code: 97112 (CPT)
- CPT Billing Code: 97112
- Insurance Median: $103
- Cash Discount Price: $92
- vs. Medicare Baseline: 3.15x 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.
Elevated Commercial Rate Alert (Value-Gap)
The negotiated rate at this facility is 315% of the Medicare baseline (a markup of 215%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
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 | $28 - $118 | 86% |
| Medicaid / KanCare | $28 - $103 | 86% |
| Blue Cross Blue Shield | $28 - $103 | 86% |
| Humana | $30 - $135 | 92% |
| Medicare (plans) | $31 - $107 | 95% |
| Health Systems Inc Contracted [320174] | $61 | 186% |
| Insurance System Inc Contracted [320465] | $61 | 186% |
| Administrative Payor Contracted [320005] | $64 | 196% |
| Indian Health Service Contracted [320198] | $103 | 315% |
| Dept Of Veteran Affairs Contracted [320106] | $103 | 315% |
| Aetna | $103 - $128 | 315% |
| Halo Hcr Inc Hospice Contracted [320432] | $103 | 315% |
| Qual Choice Contracted [320325] | $103 | 315% |
| Provider Partners Health Plans Contracted [320450] | $103 | 315% |
| Kindful Hospice Contracted [320434] | $103 | 315% |
| Ambetter / Centene | $103 | 315% |
| Halo Hcr Inc Hospice [20432] | $103 | 315% |
| Kindful Hospice [20434] | $103 | 315% |
| Novasys Contracted [320285] | $103 | 315% |
| Pace Of The Ozarks Contracted [320518] | $103 | 315% |
| Mercy Hospice Okc [20252] | $103 | 315% |
| Globalhealth Contracted [320145] | $103 | 315% |
| Tricare | $103 | 315% |
| Mercy Mgd Behavioral Health Contracted [320259] | $103 | 315% |
| Cigna | $103 | 315% |
| Elara Caring Aspire Hospice [20433] | $103 | 315% |
| Centurion Of Missouri [20459] | $103 | 315% |
| Home State Health Plan Contracted [320187] | $103 | 315% |
| Cross Timbers Hospice [20098] | $103 | 315% |
| Cherokee Nation Health Serv Contracted [320066] | $103 | 315% |
| Medical Associates Health Contracted [320444] | $103 | 315% |
| Healthscope Contracted [320182] | $109 | 333% |
| Workers Comp [20426] | $114 - $121 | 348% |
| United Medical Resources Contracted [320454] | $118 - $135 | 361% |
| Medica Contracted [320239] | $127 | 388% |
| American Healthcare Alliance Contracted [320020] | $128 | 391% |
| Preferred Health Plan Contracted [320522] | $128 | 391% |
| Healthlink Contracted [320179] | $128 - $135 | 391% |
| First Health Contracted [320128] | $128 | 391% |
| Federal Medical Center Contracted [320127] | $128 | 391% |
| Mercy Benefit Admin Contracted [320251] | $128 - $135 | 391% |
| Usa Managed Care Org Contracted [320429] | $128 | 391% |
| Point C Contracted [320238] | $135 | 412% |
| Yuzu Health Contracted [320521] | $135 | 412% |
| Ppo Plus Contracted [320310] | $135 | 412% |
| Private Health Care Systems Contracted [320320] | $135 | 412% |
| Auxiant Contracted [320462] | $135 | 412% |
| Aither Health Contracted [320449] | $135 | 412% |
| Ebms Contracted [320493] | $135 | 412% |
| Show-Me Health Administrators Contracted [320483] | $135 | 412% |
| 90 Degree Benefits Contracted [320436] | $135 | 412% |
| Benefit Management Contracted [320052] | $135 | 412% |
| Edison Health Solutions Contracted [320502] | $135 | 412% |
| Imagine 360 Contracted [320494] | $135 | 412% |
| Reflect Health Contracted [320492] | $135 | 412% |
Consumer Guidance & Cost Commentary
For the CPT code 97112, Physical therapy (neuromuscular re-education), the gross chargemaster rate at Mercy Hospital Columbus is $142.00. While the facility's cash median is $92.00, which is lower than the negotiated rates paid by most commercial payers, patients should be aware that insurance negotiated rates often exceed cash prices due to administrative overhead and contract structures. For instance, UnitedHealthcare and Humana have negotiated ranges starting as high as $118 and $135 respectively, meaning a patient with a high-deductible plan might save money by paying the cash rate of $92.00 directly, provided they qualify for a self-pay or prompt-pay discount. It is crucial to verify the specific "self-pay" or "prompt-pay" rates with the hospital before scheduling, as these upfront discounts can bypass the higher costs associated with insurance billing cycles and claims processing.
When evaluating the cost of this service, it is important to compare rates against the Medicare benchmark rather than the inflated chargemaster list. The Medicare allowed amount for this procedure is $32.73, which serves as the objective baseline for fair pricing; commercial negotiated rates typically range from 200% to 300% of this figure, though fair pricing is often defined between 120% and 150%. Additionally, patients should request a detailed, itemized billing audit if they receive a summary bill, as over 80% of hospital bills contain errors such as code unbundling or charges for services not rendered. If a balance bill arises from an out-of-network provider, the No Surprises Act may