CMS Price Transparency Data

Physical therapy (neuromuscular re-education)

Facility: Independence Health System Butler Memorial Hospita

Billing Code: 97112 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97112
Insurance Median: $63
Cash Discount Price: $161
vs. Medicare Baseline: 1.92x Medicare

The contracted insurance negotiated median rate for a Physical therapy (neuromuscular re-education) at Independence Health System Butler Memorial Hospita is $63. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $161. Compared to the federal Medicare reimbursement reference rate of $32.73, this hospital’s rate is 1.92x the Medicare baseline. Located in One Hospital Way, Butler, PA.

Cash / Self-Pay

$161

Average discount available for prompt cash payment at this facility.

Insurance Median

$63

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: $161 (492%)

Insurance Median: $63 (192%)

Cash: $161 (492% of Medicare)

Ins. Median: $63 (192% 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
Upmc	$12 - $242	37%
Highmark	$30 - $65	92%
Life Butler County	$31	95%
Martin'S Point - Usfhp	$31 - $80	95%
Medicare (plans)	$31	95%
Peak Health	$31 - $161	95%
Provider Partners	$31	95%
Tricare	$31	95%
UnitedHealthcare	$31 - $34	95%
Aetna	$32 - $184	98%
Amerihealth	$32	98%
Geisinger	$32 - $230	98%
Humana	$32	98%
Devoted Health Plan	$33 - $92	101%
Gateway	$33 - $242	101%
Pa Health & Wellness	$33	101%
The Health Plan	$33 - $73	101%
American Health Plan	$34	104%
Pnoa	$34 - $184	104%
Highmark Aca - Direct Blue	$41 - $43	125%
Highmark - Ind.& Managed Care	$43 - $72	131%
Highmark Community Blue	$43 - $64	131%
Workers Comp	$43	131%
Ccbh - Behavioral Health	$50 - $115	153%
Ellwood Group	$62 - $99	189%
Cigna	$77 - $115	235%
Private Healthcare Systems	$161 - $196	492%
Devon	$172	526%
Intergroup	$184	562%
Multiplan	$207	632%

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 $161.
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 Independence Health System Butler Memorial Hospita 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.