CMS Price Transparency Data

Physical therapy (neuromuscular re-education)

Facility: UPMC Wellsboro

Billing Code: 97112 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97112
Insurance Median: $121
Cash Discount Price: $130
vs. Medicare Baseline: 3.70x Medicare

The contracted insurance negotiated median rate for a Physical therapy (neuromuscular re-education) at UPMC Wellsboro is $121. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $130. Compared to the federal Medicare reimbursement reference rate of $32.73, this hospital’s rate is 3.70x the Medicare baseline. Located in 32-36 Central Avenue, Wellsboro, PA.

Cash / Self-Pay

$130

Average discount available for prompt cash payment at this facility.

Insurance Median

$121

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: $130 (397%)

Insurance Median: $121 (370%)

Cash: $130 (397% of Medicare)

Ins. Median: $121 (370% 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 370% of the Medicare baseline (a markup of 270%). 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
Amerihealth Caritas	$18	55%
Geisinger	$18 - $145	55%
Upmc Health Plan	$18 - $95	55%
Highmark Wholecare (Prev Gateway)	$19 - $43	58%
UnitedHealthcare	$21 - $184	64%
Health Partners Plans (Jefferson Health Plan)	$25	76%
Aetna	$28 - $187	86%
Pa Health & Wellness	$29 - $47	89%
Blue Cross Blue Shield	$31 - $110	95%
Cigna	$33 - $46	101%
Upmc Work Partners	$36	110%
Wirerope Works	$87 - $121	266%
Multiplan	$122 - $206	373%
America'S Choice	$140 - $195	428%
Intergroup	$140 - $195	428%

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 $130.
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 UPMC Wellsboro 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.