Physical therapy (neuromuscular re-education)
Facility: Nmc Health
Billing Code: 97112 (CPT)
- CPT Billing Code: 97112
- Insurance Median: $64
- Cash Discount Price: $71
- vs. Medicare Baseline: 1.96x 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 |
|---|---|---|
| Bluestem Pace | $31 | 95% |
| Wppa | $32 - $87 | 98% |
| Occunet | $35 - $95 | 107% |
| Medincrease Health Plan | $38 - $103 | 116% |
| Samaritan Ministries International | $38 - $103 | 116% |
| Prime Health Services | $44 - $119 | 134% |
| Medicaid / KanCare | $50 | 153% |
| Leading Age | $50 | 153% |
| Blue Cross Blue Shield | $51 | 156% |
| UnitedHealthcare | $52 - $142 | 159% |
| Cigna | $55 - $150 | 168% |
| Aetna | $64 - $130 | 196% |
Consumer Guidance & Cost Commentary
For physical therapy neuromuscular re-education at Nmc Health in Newton, KS, the cash price of $71.00 is significantly lower than the facility's negotiated rates with major insurers like UnitedHealthcare ($52–$142) and Cigna ($55–$150). This price difference highlights a common billing dynamic where insurance contracts often exceed cash prices due to administrative overhead and claim processing costs. If you have a high-deductible plan, paying the cash price of $71.00 upfront could save you money compared to your insurance's negotiated rate, provided you have not yet met your deductible. Additionally, patients should explicitly ask the hospital about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront payment incentives can further reduce the final bill.
It is important to understand that commercial insurance rates are not always the lowest option available. In this case, the cash price of $71.00 is also lower than the Medicare benchmark of $32.73 when adjusted for the facility's specific markup context, though the primary takeaway is that commercial plans often pay more than cash. If you receive a bill from an out-of-network provider at this facility, you may be subject to balance billing for the difference between the provider's full charge and your insurance's allowed amount. However, under the No Surprises Act, you are protected from balance billing for emergency care and non-emergency services at in-network facilities. If you do receive an unexpected bill, do not pay immediately; instead, request an itemized audit to identify errors such as unbundled codes or services not rendered, and dispute the balance bill with your insurer.