Physical therapy (neuromuscular re-education)
Facility: Providence Medical Center
Billing Code: 97112 (CPT)
- CPT Billing Code: 97112
- Insurance Median: $33
- Cash Discount Price: $31
- vs. Medicare Baseline: 1.01x 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 |
|---|---|---|
| Aetna | $25 - $48 | 76% |
| Medicaid / KanCare | $27 | 82% |
| UnitedHealthcare | $27 - $137 | 82% |
| Healthy Blue | $28 - $33 | 86% |
| Celtic | $28 - $50 | 86% |
| Midland Care Connection | $31 | 95% |
| Blue Cross Blue Shield | $31 - $73 | 95% |
| Tricare | $31 | 95% |
| Medicare (plans) | $31 | 95% |
| Cigna | $31 | 95% |
| Kansas Superior Select | $33 | 101% |
| Corizon | $40 | 122% |
| Employer Direct Healthcare | $43 | 131% |
| Well Path Prison | $43 | 131% |
| Centurion | $47 | 144% |
| Naphcare | $48 | 147% |
Consumer Guidance & Cost Commentary
For CPT code 97112, Physical therapy (neuromuscular re-education), at Providence Medical Center in Kansas City, KS, the cash price is $31.00, which is significantly lower than the facility's negotiated rates. While the facility's cash rate is $31.00, the median negotiated rate across payers is $33.00, and the gross chargemaster price is $319.00. This pricing structure highlights the potential for balance billing if a patient receives care from an out-of-network provider or if ancillary services are not covered under a contract. Under the No Surprises Act, balance billing for emergency care and non-emergency services at in-network facilities is banned, but patients should still verify that all services rendered are covered by their plan to avoid unexpected charges.
Patients should consider that paying cash upfront may be more cost-effective than relying on insurance, especially if their deductible has not been met or if the insurance negotiated rate exceeds the cash price. The facility offers a prompt-pay discount for upfront payment, which can reduce the total cost further. To ensure the lowest possible out-of-pocket expense, patients should request a self-pay or prompt-pay rate before scheduling services and sign a waiver of insurance submission to prevent automatic claims processing. Additionally, patients should request an itemized billing audit to review every line item for errors, unbundled codes, or services not rendered, as over 80% of hospital bills contain errors that can be corrected to reduce medical debt.