CMS Price Transparency Data

Physical therapy (neuromuscular re-education)

Facility: Iowa Specialty Hospital - Clarion

Billing Code: 97112 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97112
Insurance Median: $80
Cash Discount Price: $60
vs. Medicare Baseline: 2.44x Medicare

The contracted insurance negotiated median rate for a Physical therapy (neuromuscular re-education) at Iowa Specialty Hospital - Clarion is $80. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $60. Compared to the federal Medicare reimbursement reference rate of $32.73, this hospital’s rate is 2.44x the Medicare baseline. Located in 1316 South Main Street, Clarion, IA.

Cash / Self-Pay

$60

Average discount available for prompt cash payment at this facility.

Insurance Median

$80

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: $60 (183%)

Insurance Median: $80 (244%)

Cash: $60 (183% of Medicare)

Ins. Median: $80 (244% 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 244% of the Medicare baseline (a markup of 144%). 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
Tricare	$29 - $33	89%
Triwest Va - All Plans	$29 - $33	89%
Healthscope Stellar-All Plans	$49 - $56	150%
Auxiant Clarion Schools-All Plans	$60 - $70	183%
Health Partners Prestage	$70 - $80	214%
Health Partners Ish-All Other Plans	$74 - $86	226%
Aetna	$79 - $91	241%
UnitedHealthcare	$88 - $102	269%
Cigna	$90 - $104	275%
Midlands Choice-All Plans	$90 - $104	275%
Wellmark Hmo	$158	483%
Wellmark Ppo - All Other Plans	$174	532%

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 $60.
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 Iowa Specialty Hospital - Clarion 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.