CMS Price Transparency Data

Physical therapy (neuromuscular re-education)

Facility: Adena Pike Medical Center

Billing Code: 97112 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97112
Insurance Median: $174
Cash Discount Price: $115
vs. Medicare Baseline: 5.32x Medicare

The contracted insurance negotiated median rate for a Physical therapy (neuromuscular re-education) at Adena Pike Medical Center is $174. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $115. Compared to the federal Medicare reimbursement reference rate of $32.73, this hospital’s rate is 5.32x the Medicare baseline. Located in 100 Dawn Lane, Waverly, OH.

Cash / Self-Pay

$115

Average discount available for prompt cash payment at this facility.

Insurance Median

$174

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: $115 (351%)

Insurance Median: $174 (532%)

Cash: $115 (351% of Medicare)

Ins. Median: $174 (532% 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 532% of the Medicare baseline (a markup of 432%). 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
Aetna	$55 - $188	168%
Blue Cross Blue Shield	$55 - $199	168%
Buckeye Community Health Plan	$55	168%
Humana	$55 - $219	168%
Medical Mutual Of Ohio	$55 - $147	168%
Medigold	$55	168%
Molina	$55	168%
Care Source	$56	171%
Gateway Health	$76	232%
Molina Marketplace	$91	278%
Care Source Just4Me	$100	306%
Sidecar Health	$152	464%
Ohio Ppo Connect	$162	495%
The Health Plan	$162	495%
Cigna	$167	510%
Medical Mutual Of Ohio Supermed	$174	532%
First Health	$181	553%
Ohio Health Choice	$184	562%
UnitedHealthcare	$198	605%
Integrated Health Plan	$217	663%
Healthsmart	$219	669%
Multiplan/Private Healthcare Systems	$219	669%
Three Rivers Network	$219	669%

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 $115.
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 Adena Pike 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.