Physical therapy (neuromuscular re-education)
Facility: Hiawatha Community Hospital
Billing Code: 97112 (CPT)
- CPT Billing Code: 97112
- Insurance Median: $150
- Cash Discount Price: $193
- vs. Medicare Baseline: 4.58x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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 458% of the Medicare baseline (a markup of 358%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Blue Cross Blue Shield | $48 - $50 | 147% |
| Aetna | $71 - $156 | 217% |
| UnitedHealthcare | $71 - $166 | 217% |
| Humana | $72 | 220% |
| Ambetter / Centene | $86 | 263% |
| Centrus Health Direct - All Plans | $145 | 443% |
| Oscar - All Plans | $145 | 443% |
| Preferred Hlth - All Plans | $174 | 532% |
| Cigna | $183 | 559% |
| Wppa Providrs Care - All Plans | $183 | 559% |
| Midlands Choice - All Plans | $187 | 571% |
| Multiplan - All Plans | $187 | 571% |
| Healthy Blue Mcaid - All Plans | $193 | 590% |
Consumer Guidance & Cost Commentary
For this physical therapy service at Hiawatha Community Hospital, the cash price of $193.00 is identical to the facility's negotiated rates with most major insurers, including Aetna, UnitedHealthcare, and Humana. While the median negotiated amount across all payers is $145.00, many commercial plans actually pay the full cash price of $193.00, meaning patients with high-deductible plans might save money by paying out-of-pocket rather than relying on insurance. It is important to note that the facility's cash rate of $193.00 is significantly higher than the Medicare benchmark of $32.73, reflecting a markup common in commercial billing where negotiated rates often average 200% to 300% of the federal baseline.
Patients should be aware that while the No Surprises Act protects against balance billing for out-of-network providers at in-network facilities, this specific service appears to be billed at the full cash price for many plans, which can occur if the provider is considered out-of-network for that specific code or if the contract allows for full chargemaster billing. To minimize costs, you should request a prompt-pay discount before scheduling, as paying the bill upfront can often reduce the amount owed by 20% to 50%. Additionally, if you receive a summary bill, demand a full itemized audit to ensure no unbundled charges or services not rendered are included, as over 80% of hospital bills contain errors that can be corrected through a formal written dispute.