CMS Price Transparency Data

Physical therapy (neuromuscular re-education)

Facility: Mercy Hospital Washington

Billing Code: 97112 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97112
Insurance Median: $133
Cash Discount Price: $114
vs. Medicare Baseline: 4.06x Medicare

The contracted insurance negotiated median rate for a Physical therapy (neuromuscular re-education) at Mercy Hospital Washington is $133. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $114. Compared to the federal Medicare reimbursement reference rate of $32.73, this hospital’s rate is 4.06x the Medicare baseline. Located in 901 East 5Th Street, Washington, MO.

Cash / Self-Pay

$114

Average discount available for prompt cash payment at this facility.

Insurance Median

$133

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: $114 (348%)

Insurance Median: $133 (406%)

Cash: $114 (348% of Medicare)

Ins. Median: $133 (406% 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 406% of the Medicare baseline (a markup of 306%). 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
Medicaid / KanCare	$11 - $145	34%
Aetna	$26 - $184	79%
American Health Advantage Of Mo Mcr [10473]	$29	89%
Blue Cross Blue Shield	$29 - $274	89%
Cherokee Nation Health Serv Contracted [320066]	$29	89%
Cross Timbers Hospice [20098]	$29	89%
Dept Of Veteran Affairs Contracted [320106]	$29	89%
Elara Caring Aspire Hospice Contracted [320433]	$29	89%
Elara Caring Aspire Hospice [20433]	$29	89%
Globalhealth Contracted [320145]	$29	89%
Halo Hcr Inc Hospice Contracted [320432]	$29	89%
Halo Hcr Inc Hospice [20432]	$29	89%
Humana	$29	89%
Kindful Hospice Contracted [320434]	$29	89%
Kindful Hospice [20434]	$29	89%
Medicare (plans)	$29 - $176	89%
Mercy Hospice Okc [20252]	$29	89%
Pace Of The Ozarks Contracted [320518]	$29	89%
Qual Choice Contracted [320325]	$29	89%
Tricare	$29	89%
UnitedHealthcare	$29 - $193	89%
Cigna	$31 - $198	95%
Provider Partners Health Plans Contracted [320450]	$32	98%
Healthscope Contracted [320182]	$37	113%
Centivo Contracted [320505]	$49	150%
Preferred Health Plan Contracted [320522]	$52	159%
Hope Trust Contracted [320488]	$70	214%
Health Choices Contracted [320448]	$106	324%
Health Choices [20448]	$106	324%
Medical Associates Health Contracted [320444]	$106	324%
Federal Medical Center Contracted [320127]	$114	348%
Insurance System Inc Contracted [320465]	$114	348%
Point C Contracted [320238]	$114	348%
Tri State Healthcare Coalition Contracted [320379]	$114	348%
Healthlink Contracted [320179]	$120 - $225	367%
First Health Contracted [320128]	$123 - $125	376%
Mercy Mgd Behavioral Health Contracted [320259]	$123	376%
Multiplan Contracted [320270]	$123 - $132	376%
Private Health Care Systems Contracted [320320]	$123	376%
Workers Comp [20426]	$132 - $141	403%
Medica Contracted [320239]	$137	419%
Ambetter / Centene	$145	443%
Home State Health Plan Contracted [320187]	$145	443%
Novasys Contracted [320285]	$145	443%
Mercy Benefit Admin Contracted [320251]	$170 - $209	519%
Mercy Benefit Admin [20251]	$170 - $209	519%
United Medical Resources Contracted [320454]	$193	590%
Show-Me Health Administrators Contracted [320483]	$203 - $213	620%
Aither Health Contracted [320449]	$209	639%
Aither Health [20449]	$209	639%
Auxiant Contracted [320462]	$209	639%
Ebms Contracted [320493]	$209	639%
Edison Health Solutions Contracted [320502]	$209	639%
Imagine 360 Contracted [320494]	$209	639%
Reflect Health Contracted [320492]	$209	639%
Yuzu Health Contracted [320521]	$209	639%

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 $114.
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 Mercy Hospital Washington 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.