CMS Price Transparency Data

Physical therapy (neuromuscular re-education)

Facility: Sanford Hillsboro

Billing Code: 97112 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97112
Insurance Median: $115
Cash Discount Price: $111
vs. Medicare Baseline: 3.51x Medicare

The contracted insurance negotiated median rate for a Physical therapy (neuromuscular re-education) at Sanford Hillsboro is $115. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $111. Compared to the federal Medicare reimbursement reference rate of $32.73, this hospital’s rate is 3.51x the Medicare baseline. Located in 12 Third Street Se, Hillsboro, ND.

Cash / Self-Pay

$111

Average discount available for prompt cash payment at this facility.

Insurance Median

$115

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: $111 (339%)

Insurance Median: $115 (351%)

Cash: $111 (339% of Medicare)

Ins. Median: $115 (351% 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 351% of the Medicare baseline (a markup of 251%). 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
Blue Cross Blue Shield	$63 - $126	192%
Sanford Health Plan Align	$63	192%
Ucare	$68 - $122	208%
Aetna	$69 - $121	211%
Health Partners	$69 - $108	211%
Medicare (plans)	$69	211%
UnitedHealthcare	$69 - $116	211%
Primewest	$70	214%
Security Health Plan	$76	232%
Sanford Health Plan	$110 - $129	336%
Medica	$115 - $123	351%
First Choice Health Network	$125	382%
Healthez	$125	382%
Multiplan	$125	382%

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 $111.
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 Sanford Hillsboro 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.