CMS Price Transparency Data

Physical therapy (neuromuscular re-education)

Facility: Gundersen Palmer Lutheran Hospital and Clinics

Billing Code: 97112 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97112
Insurance Median: $61
Cash Discount Price: $62
vs. Medicare Baseline: 1.86x Medicare

The contracted insurance negotiated median rate for a Physical therapy (neuromuscular re-education) at Gundersen Palmer Lutheran Hospital and Clinics is $61. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $62. Compared to the federal Medicare reimbursement reference rate of $32.73, this hospital’s rate is 1.86x the Medicare baseline. Located in 112 Jefferson Street, West Union, IA.

Cash / Self-Pay

$62

Average discount available for prompt cash payment at this facility.

Insurance Median

$61

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: $62 (189%)

Insurance Median: $61 (186%)

Cash: $62 (189% of Medicare)

Ins. Median: $61 (186% 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
Amerigroup	$15 - $57	46%
Molina Health	$15	46%
Health Partners	$55 - $97	168%
UnitedHealthcare	$55 - $57	168%
Wellmark	$56 - $91	171%
Humana	$57	174%
Iowa Total Care	$57	174%
Managed Health Service	$57	174%
Ucare	$57 - $88	174%
Quartz	$60	183%
Alliance	$87 - $178	266%
Medical Associates	$88	269%
Aspirus Arise Health	$91	278%
Multiplan/Healtheos	$97 - $102	296%
Coventry Health Care	$104	318%
Midland Choice	$107	327%

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 $62.
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 Gundersen Palmer Lutheran Hospital and Clinics 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.