CMS Price Transparency Data

Physical therapy (neuromuscular re-education)

Facility: Excela Health - Frick Hospital

Billing Code: 97112 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97112
Insurance Median: $34
Cash Discount Price: $53
vs. Medicare Baseline: 1.04x Medicare

The contracted insurance negotiated median rate for a Physical therapy (neuromuscular re-education) at Excela Health - Frick Hospital is $34. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $53. Compared to the federal Medicare reimbursement reference rate of $32.73, this hospital’s rate is 1.04x the Medicare baseline. Located in 508 South Church Street, Mount Pleasant, PA.

Cash / Self-Pay

$53

Average discount available for prompt cash payment at this facility.

Insurance Median

$34

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: $53 (162%)

Insurance Median: $34 (104%)

Cash: $53 (162% of Medicare)

Ins. Median: $34 (104% 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.

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
Upmc For Kids Chip	$12	37%
Highmark Advantage Community Blue	$29	89%
Va	$31	95%
Aetna	$32 - $71	98%
Amerihealth Caritas	$32	98%
Cigna	$32 - $77	98%
Devoted	$32	98%
Geisinger	$32	98%
Health Partners Plan	$32	98%
Humana	$32	98%
Martin'S Point	$32	98%
Peak Health	$32 - $73	98%
United	$32	98%
Pa Health And Wellness	$33	101%
The Health Plan Of West Virginia	$33 - $73	101%
Upmc	$33	101%
American Health Plan Of Pa	$34	104%
Highmark Wholecare	$34	104%
Provider Network Of America	$34 - $70	104%
Provider Plan Partners Plan	$34	104%
UnitedHealthcare	$34	104%
Upmc Health Plan	$36 - $53	110%
Highmark Children'S Health Insurance Program	$37	113%
Ambetter / Centene	$39	119%
Highmark	$42 - $68	128%
Velocity	$46	141%
Community Blue	$61	186%

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 $53.
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 Excela Health - Frick Hospital 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.