Physical therapy (neuromuscular re-education)
Facility: Saint Luke'S South Hospital
Billing Code: 97112 (CPT)
- CPT Billing Code: 97112
- Insurance Median: $90
- Cash Discount Price: $173
- vs. Medicare Baseline: 2.75x 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 275% of the Medicare baseline (a markup of 175%). 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 |
|---|---|---|
| Aetna | $21 - $274 | 64% |
| Medicaid / KanCare | $27 - $42 | 82% |
| Transplants-Case Rates [5750] | $29 - $288 | 89% |
| UnitedHealthcare | $38 - $127 | 116% |
| Blue Cross Blue Shield | $39 - $90 | 119% |
| Humana | $59 - $92 | 180% |
| Cigna | $78 - $289 | 238% |
| First Health [5512] | $171 | 522% |
| Commercial-Contracted [8000] | $203 - $233 | 620% |
Consumer Guidance & Cost Commentary
For this physical therapy session at Saint Luke's South Hospital in Overland Park, KS, the cash price of $288 is significantly higher than the facility's negotiated rate of $90 and the state average cash median of $173. While insurance plans like Aetna and UnitedHealthcare negotiate rates ranging from $21 to $127, these amounts often exceed the cash price, meaning patients with high-deductible plans might save money by paying out-of-pocket and asking for a prompt-pay discount before scheduling. It is crucial to request a self-pay classification and a prompt-pay fee reduction upfront, as waiting until after receiving a bill can result in losing these discounts; signing a waiver to prevent automatic claims submission ensures the facility applies the lower cash rate rather than processing a claim at the higher negotiated amount.
The facility's charged amount of $288 is approximately 2.7 times the Medicare benchmark of $32.73, highlighting the substantial markup common in commercial billing. Although the facility offers a 4-star rating and is a voluntary non-profit, patients should be aware that balance billing could occur if out-of-network ancillary services are used, though the No Surprises Act protects against such billing for emergency care and non-emergency services at in-network facilities. To avoid unexpected costs, patients should demand an itemized billing audit before paying, ensuring no unbundled codes or services not rendered are included, and should verify their deductible status to understand if their insurance will cover any portion of the service or if they are responsible for the full negotiated or cash amount.