CMS Price Transparency Data

Physical therapy (neuromuscular re-education)

Facility: Fairfield Medical Center

Billing Code: 97112 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97112
Insurance Median: $90
Cash Discount Price: $78
vs. Medicare Baseline: 2.75x Medicare

The contracted insurance negotiated median rate for a Physical therapy (neuromuscular re-education) at Fairfield Medical Center is $90. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $78. Compared to the federal Medicare reimbursement reference rate of $32.73, this hospital’s rate is 2.75x the Medicare baseline. Located in 401 North Ewing Street, Lancaster, OH.

Cash / Self-Pay

$78

Average discount available for prompt cash payment at this facility.

Insurance Median

$90

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: $78 (238%)

Insurance Median: $90 (275%)

Cash: $78 (238% of Medicare)

Ins. Median: $90 (275% 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 275% of the Medicare baseline (a markup of 175%). 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
Humana	$28 - $164	86%
Aetna	$31 - $113	95%
Blue Cross Blue Shield	$31 - $26,250	95%
Buckeye Community Health	$31 - $83	95%
Medical Mutual	$31 - $33,500	95%
Medicare (plans)	$31	95%
Medigold	$31	95%
Molina	$31 - $79	95%
The Health Plan	$31 - $120	95%
UnitedHealthcare	$31 - $141	95%
Va Ccn	$31	95%
Valor Health Plan	$31	95%
Caresource	$32 - $80	98%
Bwc	$44	134%
Oscar	$58	177%
Medicaid / KanCare	$79	241%
Amerihealth Caritas Ohio	$83	254%
Allied Benefit Systems	$120	367%
Meritain Health	$120	367%
Quality Care Partners/Ohio Ppo Connect	$125	382%
The Ohio State Health Plan	$133	406%
Cigna	$143	437%
Ohio Healthy	$163	498%
Multiplan	$164	501%
Miscellaneous Plans	$173	529%

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 $78.
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 Fairfield Medical Center 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.