CMS Price Transparency Data

Physical therapy (neuromuscular re-education)

Facility: Spanish Peaks Regional Health Center

Billing Code: 97112 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97112
Insurance Median: $60
Cash Discount Price: $105
vs. Medicare Baseline: 1.83x Medicare

The contracted insurance negotiated median rate for a Physical therapy (neuromuscular re-education) at Spanish Peaks Regional Health Center is $60. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $105. Compared to the federal Medicare reimbursement reference rate of $32.73, this hospital’s rate is 1.83x the Medicare baseline. Located in 23500 Us Highway 160, Walsenburg, CO.

Cash / Self-Pay

$105

Average discount available for prompt cash payment at this facility.

Insurance Median

$60

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: $105 (321%)

Insurance Median: $60 (183%)

Cash: $105 (321% of Medicare)

Ins. Median: $60 (183% 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
Humana	$34 - $60	104%
Kaiser Ppo Mcr	$34 - $123	104%
Medicare (plans)	$34 - $60	104%
UnitedHealthcare	$34 - $114	104%
Devoted Health Mcr - All Plans	$36 - $63	110%
Apostrophe - All Plans	$44 - $111	134%
Blue Cross Blue Shield	$44 - $111	134%
Cofinity - All Plans	$44 - $113	134%
Connect For Health - All Plans	$44 - $114	134%
Friday Hp Chp - All Plans	$44 - $111	134%
Prov Ntwrk Of America - All Plans	$47 - $111	144%
Rmhp - All Plans	$51 - $114	156%
Kaiser Ppo - All Other Plans	$54 - $111	165%
Beacon Health Op Only-All Plans	$56 - $110	171%
Cigna	$99 - $111	302%
Multiplan Phcs - All Plans	$99 - $117	302%

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 $105.
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 Spanish Peaks Regional Health 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.