CMS Price Transparency Data
Physical therapy (neuromuscular re-education)
Facility: Seattle Children's Hospital
Billing Code: 97112 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 97112
- Insurance Median: $165
- Cash Discount Price: $194
- vs. Medicare Baseline: 5.04x Medicare
The contracted insurance negotiated median rate for a Physical therapy (neuromuscular re-education) at Seattle Children's Hospital is $165. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $194. Compared to the federal Medicare reimbursement reference rate of $32.73, this hospital’s rate is 5.04x the Medicare baseline. Located in 4800 Sand Point Way Ne, Po Box C-5371, Seattle, WA.
Cash / Self-Pay
$194
Average discount available for prompt cash payment at this facility.
Insurance Median
$165
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: $194 (593%)
Insurance Median: $165 (504%)
Cash: $194 (593% of Medicare)
Ins. Median: $165 (504% 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 504% of the Medicare baseline (a markup of 404%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
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Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Child Hearing League [17301] | $19 | 58% |
| Hospice [17306] | $19 | 58% |
| Maple Lane School [17309] | $19 | 58% |
| Medicaid / KanCare | $19 | 58% |
| Chpw [15802] | $20 | 61% |
| Coordinated Care [15815] | $20 | 61% |
| Eye Quest [15894] | $20 | 61% |
| Icw Wellpoint [15822] | $20 | 61% |
| Kaiser [15818] | $20 | 61% |
| Molina [15809] | $20 | 61% |
| Opticare [15895] | $20 | 61% |
| UnitedHealthcare | $20 - $165 | 61% |
| Wellpoint [15814] | $20 | 61% |
| Ubh Community & State [15819] | $25 | 76% |
| Usfhp [12208] | $80 | 244% |
| Asuris [11913] | $105 | 321% |
| Bridgespan Health Company [11906] | $105 | 321% |
| Premera [11600] | $105 - $161 | 321% |
| Regence [11903] | $105 - $161 | 321% |
| Regence [11909] | $105 | 321% |
| Chpw Cascade [12228] | $107 | 327% |
| Coordinated Care [12267] | $107 - $146 | 327% |
| Kaiser [13400] | $107 - $146 | 327% |
| Kaiser [13401] | $126 | 385% |
| Regence Ump [12263] | $126 | 385% |
| Administrators [13102] | $146 - $165 | 446% |
| Molina Marketplace [12831] | $146 | 446% |
| Asuris [11900] | $161 | 492% |
| Blue Cross Blue Shield | $161 | 492% |
| Aetna | $163 | 498% |
| Ameriben [11006] | $163 | 498% |
| Christian Brothers [11001] | $163 | 498% |
| Coresource [11004] | $163 | 498% |
| Ebms [11003] | $163 | 498% |
| Meritain [12251] | $163 - $185 | 498% |
| Moda [11009] | $163 | 498% |
| Preferred One [11008] | $163 | 498% |
| Web Tpa [11007] | $163 | 498% |
| Allegiance [12264] | $165 | 504% |
| Allied [13129] | $165 | 504% |
| Assurant Health Fc [13135] | $165 | 504% |
| Carpenters Trust [13100] | $165 | 504% |
| Cigna | $165 | 504% |
| Coastal Administrative [13140] | $165 | 504% |
| Coventry Fc [13112] | $165 | 504% |
| Ebms Fc [13144] | $165 | 504% |
| First Choice [13399] | $165 | 504% |
| Guardian Fc [13105] | $165 | 504% |
| Health Alliance [13233] | $165 | 504% |
| Ilwu-Pma [13158] | $165 | 504% |
| Kps [13109] | $165 | 504% |
| Loomis Benefits West [13161] | $165 | 504% |
| Mega Life [13111] | $165 | 504% |
| Meritain Health [13229] | $165 | 504% |
| Moda Fc [13219] | $165 | 504% |
| Myers Stevens & Toohey [13169] | $165 | 504% |
| Pacific Underwriters [13175] | $165 | 504% |
| Personify Fc [13155] | $165 | 504% |
| Personify [12270] | $165 | 504% |
| Principal Mutual Fc [13115] | $165 | 504% |
| Providence Health Plan [12289] | $165 | 504% |
| Providence Health Plan [13181] | $165 | 504% |
| Psew [13124] | $165 | 504% |
| Rehn & Associates [13182] | $165 | 504% |
| Sound Health And Wellness [13116] | $165 | 504% |
| Starmark [13103] | $165 | 504% |
| Tongass Timber Trust [13202] | $165 | 504% |
| Trusteed Plans [13186] | $165 | 504% |
| Trustmark Life Insurance [13203] | $165 | 504% |
| Tufts Health Plan [12279] | $165 | 504% |
| Welfare Pension [13120] | $165 | 504% |
| Wship [13121] | $165 | 504% |
| Zenith American Solutions [13195] | $165 | 504% |
| Zenith [13123] | $165 | 504% |
| United Behavioral Health [12234] | $171 | 522% |
| Coastal Admin Svcs Contracted [12222] | $175 | 535% |
| Personify Contracted [12205] | $175 | 535% |
| Claritev [12299] | $185 | 565% |
| Ebms [12241] | $185 | 565% |
| Health Alliance [12266] | $185 | 565% |
| Humana | $185 | 565% |
| Key Benefit Admin [12276] | $185 | 565% |
| Medical Mutual [12233] | $185 | 565% |
| Moda [12842] | $185 | 565% |
| Nippon Life Insurance [12232] | $185 | 565% |
| Pehp [12235] | $185 | 565% |
| Preferredone Admin Services [12236] | $185 | 565% |
| Select Health [12277] | $185 | 565% |
| Altius Health Plan [12275] | $187 | 571% |
| Coventry Mhbp [12272] | $187 | 571% |
| Coventry [12244] | $187 | 571% |
| First Health [12210] | $187 | 571% |
| Hcc Medical [12274] | $187 | 571% |
| Lewermark [12286] | $187 | 571% |
| Medishare [12287] | $187 | 571% |
| Pacificsource [12245] | $187 | 571% |
| Rural Carrier Benefit Plan [12271] | $187 | 571% |