Physical therapy (neuromuscular re-education)
Facility: Golden Valley Memorial Hospital
Billing Code: 97112 (CPT)
- CPT Billing Code: 97112
- Insurance Median: $32
- Cash Discount Price: $95
- 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 |
|---|---|---|
| Aetna | $30 | 92% |
| Humana | $30 | 92% |
| UnitedHealthcare | $30 - $51 | 92% |
| Home State Health | $32 | 98% |
| Ambetter / Centene | $36 | 110% |
| Medica | $166 | 507% |
Consumer Guidance & Cost Commentary
If you are paying cash for this physical therapy service, you should know that the facility's cash median rate is $95, which is significantly lower than the gross chargemaster price of $159. While commercial insurance negotiated rates can sometimes be higher due to administrative costs, this cash price offers a baseline that you can compare against your specific plan. It is important to verify with the hospital if they offer a "prompt-pay" discount, which could further reduce your out-of-pocket cost if you settle the bill upfront.
In the broader context of pricing, the facility's cash rate of $95 is notably higher than the state average of $32 and the county average of $32.73. This indicates that while the cash price is accessible, commercial insurance members may face higher out-of-network or allowed amounts depending on their carrier. For instance, the highest negotiated rate among in-network payers is $166, which exceeds the cash price. Because commercial rates often include administrative overhead and contract markups, patients with high-deductible plans might find paying the cash rate of $95 more cost-effective than relying on an insurance allowed amount that could exceed this figure.