97113

Therapy procedure using water pool to exercises, each 15 minutes

Medicare pricing data for 6,798 providers across 52 states

🤖AI Overview

This is one of the most commonly performed procedures in Medicare, with 1.6 million services annually. Even small pricing inefficiencies here affect millions of patients. Note: These costs reflect the Medicare physician/supplier component. Hospital facility fees are billed separately and can be 2-5x the physician fee.

💡 What You Should Know

Therapy procedure using water pool to exercises, each 15 minutes (HCPCS code 97113) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $28.23, but hospitals typically charge $72.03 — a 2.6x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$5.65

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $28.23, your out-of-pocket cost would be approximately $5.65. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$28.23
Average Hospital Charge
$72.03
Markup Ratio
2.6x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$72.03
Medicare Allowed$28.23
Medicare Payment$21.75

Hospitals charge 2.6x more than what Medicare allows for this procedure. Medicare actually pays $21.75 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Alaska$37$99537,582+29.4%
District of Columbia$32$6841,503+13.1%
New Jersey$32$8312838,543+12.2%
Massachusetts$31$6616332,726+10.1%
California$31$65610263,947+9.4%
New York$31$7736873,925+8.2%
New Hampshire$30$82304,783+5.5%
Hawaii$30$675915,863+5.3%
Maryland$30$7625695,245+4.6%
Puerto Rico$29$3951,928+4.4%
Connecticut$29$96376,898+3.4%
Vermont$29$558718,040+1.7%
North Dakota$29$93293,529+1.7%
South Dakota$28$82687,147+0.9%
Montana$28$706914,181+0.9%
Washington$28$6821351,077+0.6%
Rhode Island$28$78454,079+0.4%
Wyoming$28$708010,876+0.2%
Minnesota$28$9316912,864+0.1%
Delaware$28$838118,238-0.4%
Virginia$28$6518839,141-1.3%
Oregon$28$7918716,181-1.4%
Illinois$28$8122229,557-1.6%
Maine$28$71396,242-1.6%
Pennsylvania$28$6627160,242-1.8%
Michigan$28$11021224,118-2.4%
Colorado$27$7411619,397-2.9%
Indiana$27$998013,059-3.1%
Kentucky$27$71768,708-3.2%
Nevada$27$115418,565-3.2%
Utah$27$641008,123-3.2%
Wisconsin$27$1171099,442-3.4%
Arizona$27$6416542,205-4.2%
North Carolina$27$7525053,826-4.5%
Louisiana$27$5610127,592-4.9%
Iowa$27$827711,635-5.2%
Georgia$27$6615752,034-5.5%
Kansas$27$698924,583-5.6%
Texas$27$74434175,644-5.7%
Missouri$27$728211,958-5.8%
Idaho$27$537117,396-6.0%
Ohio$27$7124752,816-6.0%
South Carolina$27$727410,995-6.0%
West Virginia$26$597315,437-7.0%
Florida$26$7622174,734-7.2%
Nebraska$26$7913527,681-7.2%
Arkansas$26$61416,177-7.8%
Alabama$26$636011,852-7.9%
Mississippi$25$6910518,845-10.0%
Oklahoma$25$695514,623-10.2%
Tennessee$25$7512715,452-10.2%
New Mexico$25$533719,655-10.4%

⚠️ Important: These costs reflect the Medicare physician/supplier component. Hospital facility fees may be billed separately. Total out-of-pocket costs may be higher.

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