Physical therapy (neuromuscular re-education)
Facility: Saint John Hospital
Billing Code: 97112 (CPT)
- CPT Billing Code: 97112
- Insurance Median: $32
- Cash Discount Price: $31
- vs. Medicare Baseline: 0.98x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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.
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 Cross Blue Shield | $24 - $50 | 73% |
| Medicaid / KanCare | $27 | 82% |
| UnitedHealthcare | $27 - $43 | 82% |
| Healthy Blue | $28 - $33 | 86% |
| Celtic | $28 - $112 | 86% |
| Medicare (plans) | $31 | 95% |
| Aetna | $31 - $48 | 95% |
| Midland Care Connection | $31 | 95% |
| Cigna | $31 | 95% |
| Tricare | $31 | 95% |
| Kansas Superior Select | $32 | 98% |
| Employer Direct Healthcare | $43 | 131% |
| Corizon | $43 | 131% |
| Well Path | $43 | 131% |
| Centurion | $47 | 144% |
| Naphcare | $48 | 147% |
Consumer Guidance & Cost Commentary
For the CPT code 97112, representing physical therapy for neuromuscular re-education, Saint John Hospital in Leavenworth, KS, lists a gross charge of $276.00. While the facility offers a cash median rate of $31.00, which is significantly lower than the state average of $32.00 for negotiated rates, patients should be aware that insurance negotiated rates vary widely. The data shows in-network payment ranges from as low as $24.00 with Blue Cross Blue Shield to $112.00 with Celtic, meaning the cash price could be cheaper for those with high-deductible plans or those who qualify for prompt-pay discounts. It is important to note that while the No Surprises Act protects patients from balance billing for out-of-network services at in-network facilities, unexpected ancillary services or non-covered items may still result in additional charges that require an itemized billing audit to verify.
When evaluating the cost, it is essential to compare the facility's rates against the Medicare benchmark, which stands at $32.73 for this service. The facility's cash median of $31.00 is slightly below the Medicare amount, suggesting a competitive pricing structure that aligns with fair market value rather than inflated chargemaster lists. However, the median paid amount of $117.00 across payers indicates that many commercial plans negotiate rates well above the cash price due to administrative overhead and contract dynamics. Consumers are advised to request a self-pay classification before scheduling to secure the lowest possible rate and to review any itemized bills carefully to ensure no unbundled codes or services not rendered are included.