Physical therapy (neuromuscular re-education)
Facility: Mcpherson Hospital
Billing Code: 97112 (CPT)
- CPT Billing Code: 97112
- Insurance Median: $83
- Cash Discount Price: $81
- vs. Medicare Baseline: 2.54x 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.
Elevated Commercial Rate Alert (Value-Gap)
The negotiated rate at this facility is 254% of the Medicare baseline (a markup of 154%). 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.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Tricare | $27 | 82% |
| UnitedHealthcare | $31 - $109 | 95% |
| Healthy Blue Mcr Adv | $31 | 95% |
| Va Ccn - All Plans | $31 | 95% |
| Blue Cross Blue Shield | $31 | 95% |
| Wellcare Mcr Adv - All Plans | $31 | 95% |
| Humana | $31 | 95% |
| Ambetter / Centene | $36 | 110% |
| Wppa - All Plans | $76 | 232% |
| Medical Associates - All Plans | $82 | 251% |
| Central Plains - All Plans | $82 | 251% |
| Christian Health Aid - All Plans | $87 | 266% |
| Aetna | $90 - $109 | 275% |
| Multiplan - All Plans | $98 | 299% |
| Cigna | $104 | 318% |
| First Health - All Plans | $104 | 318% |
| Health Partners - All Plans | $104 | 318% |
| Medicaid / KanCare | $109 | 333% |
| Health Blue Mcaid - All Other Plans | $111 | 339% |
Consumer Guidance & Cost Commentary
For CPT code 97112, Physical therapy (neuromuscular re-education), McPherson Hospital in Kansas lists a gross charge of $109.00. The facility's cash median rate is $81.00, while the median negotiated rate across payers is $83.00. This cash price is lower than the state average of $86.00, meaning patients paying out-of-pocket may save money compared to the typical insurance payment. However, because some commercial payers have negotiated rates as high as $111.00, a patient with a high-deductible plan might find that paying the cash rate of $81.00 upfront is more cost-effective than relying on insurance, which could result in a higher allowed amount.
While the facility offers a cash rate of $81.00, patients should be aware that balance billing can occur if they receive care from out-of-network providers, where the hospital bills the difference between the full charge and the insurance allowed amount. Additionally, summary bills often obscure individual line items; patients should request a full itemized audit to verify that no unbundled codes or services not rendered are included. To minimize costs, patients should contact the hospital directly to confirm "self-pay" or "prompt-pay" discounts, which can reduce the bill by 20% to 50% if paid in full within a short window, bypassing the administrative costs associated with insurance claims processing.