CMS Price Transparency Data

Physical therapy (neuromuscular re-education)

Facility: Franklin General Hospital

Billing Code: 97112 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97112
Insurance Median: $70
Cash Discount Price: $104
vs. Medicare Baseline: 2.14x Medicare

The contracted insurance negotiated median rate for a Physical therapy (neuromuscular re-education) at Franklin General Hospital is $70. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $104. Compared to the federal Medicare reimbursement reference rate of $32.73, this hospital’s rate is 2.14x the Medicare baseline. Located in 1720 Central Avenue East, Hampton, IA.

Cash / Self-Pay

$104

Average discount available for prompt cash payment at this facility.

Insurance Median

$70

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: $104 (318%)

Insurance Median: $70 (214%)

Cash: $104 (318% of Medicare)

Ins. Median: $70 (214% 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 214% of the Medicare baseline (a markup of 114%). 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
Medical Associates Mcare	$46	141%
Mount Carmel Hp-All Plans	$46	141%
Tricare	$46	141%
UnitedHealthcare	$46 - $96	141%
Amerigroup Mcare	$47	144%
Wellmark Mcr Adv	$47	144%
Molina Mcare	$48	147%
Ambetter / Centene	$49 - $74	150%
American Hp Iowa - All Plans	$49	150%
Amerigroup Mcaid - All Other Plans	$49	150%
Molina Mcaid - All Other Plans	$49	150%
Centivo - All Plans	$70	214%
Medical Ass Hosp Employer Group	$70	214%
Oscar - All Plans	$70	214%
Midlands Choice-All Plans	$81	247%
Medical Associates Hp-All Other Plans	$99	302%
Preferred Health Choices-All Plans	$99	302%
Splashlight Llc-All Plans	$99	302%
Aetna	$108 - $110	330%
Multiplan-All Plans	$110	336%
Wellmark Hmo	$136	416%
Wellmark Ppo - All Other Plans	$150	458%

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 $104.
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 Franklin General 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.