CMS Price Transparency Data

Physical therapy (neuromuscular re-education)

Facility: Sanford Chamberlain Medical Center

Billing Code: 97112 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97112
Insurance Median: $117
Cash Discount Price: $126
vs. Medicare Baseline: 3.57x Medicare

The contracted insurance negotiated median rate for a Physical therapy (neuromuscular re-education) at Sanford Chamberlain Medical Center is $117. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $126. Compared to the federal Medicare reimbursement reference rate of $32.73, this hospital’s rate is 3.57x the Medicare baseline. Located in 300 S Byron, Chamberlain, SD.

Cash / Self-Pay

$126

Average discount available for prompt cash payment at this facility.

Insurance Median

$117

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: $126 (385%)

Insurance Median: $117 (357%)

Cash: $126 (385% of Medicare)

Ins. Median: $117 (357% 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 357% of the Medicare baseline (a markup of 257%). 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
Sanford Health Plan Align	$54	165%
Ucare	$58 - $139	177%
Wellmark Sd	$58 - $137	177%
Aetna	$59 - $137	180%
Health Partners	$59 - $118	180%
Medicare (plans)	$59	180%
UnitedHealthcare	$59 - $132	180%
Primewest	$60	183%
Sanford Health Plan	$87 - $116	266%
Security Health Plan	$87	266%
Medica	$130 - $139	397%
First Choice Health Network	$142	434%
Healthez	$142	434%
Multiplan	$142	434%

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 $126.
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 Chamberlain Medical Center 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.