CMS Price Transparency Data

Physical therapy (neuromuscular re-education)

Facility: UPMC Hamot

Billing Code: 97112 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97112
Insurance Median: $70
Cash Discount Price: $128
vs. Medicare Baseline: 2.14x Medicare

The contracted insurance negotiated median rate for a Physical therapy (neuromuscular re-education) at UPMC Hamot is $70. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $128. Compared to the federal Medicare reimbursement reference rate of $32.73, this hospital’s rate is 2.14x the Medicare baseline. Located in 201 State Street, Erie, PA.

Cash / Self-Pay

$128

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: $128 (391%)

Insurance Median: $70 (214%)

Cash: $128 (391% 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
Upmc Health Plan	$18 - $34	55%
UnitedHealthcare	$19 - $139	58%
Aetna	$20 - $149	61%
Geisinger	$23	70%
Blue Cross Blue Shield	$25 - $123	76%
Health Partners Plans (Jefferson Health Plan)	$25	76%
Highmark Wholecare (Prev Gateway)	$25 - $106	76%
Amerihealth Caritas	$26	79%
Pa Health & Wellness	$29	89%
Univera	$32 - $94	98%
Fidelis	$38 - $84	116%
Upmc Work Partners	$44	134%
Independent Health	$46 - $51	141%
Cigna	$64 - $85	196%
Molina Healthcare Of Ny	$84	257%
Intergroup	$138 - $170	422%
Multiplan	$149 - $170	455%

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 $128.
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 UPMC Hamot 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.