CMS Price Transparency Data

Physical therapy (neuromuscular re-education)

Facility: Uva Health Culpeper Medical Center

Billing Code: 97112 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97112
Insurance Median: $87
Cash Discount Price: $71
vs. Medicare Baseline: 2.66x Medicare

The contracted insurance negotiated median rate for a Physical therapy (neuromuscular re-education) at Uva Health Culpeper Medical Center is $87. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $71. Compared to the federal Medicare reimbursement reference rate of $32.73, this hospital’s rate is 2.66x the Medicare baseline. Located in 501 Sunset Lane, Culpeper, VA.

Cash / Self-Pay

$71

Average discount available for prompt cash payment at this facility.

Insurance Median

$87

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: $71 (217%)

Insurance Median: $87 (266%)

Cash: $71 (217% of Medicare)

Ins. Median: $87 (266% 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 266% of the Medicare baseline (a markup of 166%). 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 Ridge Pace [10510]	$29	89%
Medicaid / KanCare	$29	89%
Veterans [99909]	$31	95%
Aetna	$32 - $205	98%
Blue Cross Blue Shield	$32	98%
Cigna	$32 - $360	98%
HMO Part B [10099]	$32	98%
Humana	$32 - $33	98%
Medicare (plans)	$32	98%
UnitedHealthcare	$32 - $282	98%
VA Ccn [99926]	$32	98%
VA Ccn [99927]	$32	98%
Veterans Administration [99910]	$32	98%
Champva [50002]	$34	104%
Tricare	$34	104%
Carefirst [30007]	$57 - $60	174%
Sentara [40021]	$73 - $110	223%
Sentara Behavioral Health [40052]	$75 - $110	229%
Beacon Health Options [40012]	$108	330%
Multiplan Generic [40035]	$108 - $183	330%
Vhn Generic [40040]	$108 - $183	330%
Commercial Contracted Hb Only [40056]	$113	345%
Commercial Generic [40000]	$113 - $150	345%
Geha [40009]	$125 - $228	382%
Kaiser Permenente [40014]	$128	391%
Commercial Contracted Tpa [40055]	$129 - $150	394%
Umwa [40037]	$150	458%
Healthsmart [40013]	$161	492%
First Health Generic [40033]	$176	538%
Gateway Health Alliance [40034]	$183	559%
Onenet Workers Comp Generic [60010]	$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 $71.
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 Uva Health Culpeper 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.