CMS Price Transparency Data

Physical therapy (neuromuscular re-education)

Facility: Prisma Health Baptist

Billing Code: 97112 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97112
Insurance Median: $37
Cash Discount Price: $114
vs. Medicare Baseline: 1.13x Medicare

The contracted insurance negotiated median rate for a Physical therapy (neuromuscular re-education) at Prisma Health Baptist is $37. 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 1.13x the Medicare baseline. Located in 1330 Taylor at Marion St, Columbia, SC.

Cash / Self-Pay

$114

Average discount available for prompt cash payment at this facility.

Insurance Median

$37

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: $37 (113%)

Cash: $114 (348% of Medicare)

Ins. Median: $37 (113% 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
Medicaid / KanCare	$19 - $27	58%
Humana	$20 - $131	61%
UnitedHealthcare	$27 - $34	82%
Blue Cross Blue Shield	$31 - $236	95%
Cigna	$31 - $188	95%
Covid19 Hrsa Uninsured Testing & Treatment Fund [904]	$31	95%
Medicare (plans)	$31 - $33	95%
Triwest Healthcare Alliance Vcp [902]	$31	95%
Va Community Care Network-Vaccn [903]	$31	95%
Aetna	$33 - $138	101%
Healthy Conn Prime-First Choice Vip Care [5300]	$33	101%
Healthy Conn Prime-Molina Healthcare [5330]	$33	101%
Healthy Conn Prime-Wellcare Prime By Atc [5310]	$33	101%
Tricare	$33	101%
Golden Rule Insurance Company [2991]	$34	104%
Oxford Health Plans [2992]	$34	104%
Zzumr-Salt Lake City Ut [3169]	$34	104%
Prisma Health Seniorcare Pace - Midlands [5400]	$41	125%
Prisma Health Seniorcare Pace-Upstate [5200]	$41	125%
Workers Comp [600]	$44	134%
Scdc-Sc Dept Of Corrections [7232]	$56	171%
Ambetter / Centene	$58	177%
Promise Health Plan Contracted [2401]	$61 - $105	186%
Orangeburg Senior Helping Center Pace [5401]	$70	214%
Bluechoice [810]	$87 - $236	266%
Planned Administrators [820]	$87	266%
Bob Jones Univ-Pai [821]	$105	321%
Meritain Health Contracted [2200]	$112 - $138	342%
Preferred Administrators Contracted [2839]	$122	373%
Medcost [2940]	$130 - $145	397%
Atlantic Packaging Contracted [4833]	$131	400%
Nippon [2300]	$138	422%
Aps Healthcare System [2981]	$140	428%
Multiplan/Phcs Contracted [2950]	$156	477%
Vsp Vision Care [2986]	$158	483%
First Health Contracted [2952]	$163	498%
Furman Int/Allen University Student [2951]	$163	498%
Quiktrip-First Health [3067]	$163	498%
Evernorth Behavioral Contracted [2982]	$188	574%

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 Prisma Health Baptist 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.