Physical therapy (neuromuscular re-education)
Facility: Kansas City Orthopaedic Institute
Billing Code: 97112 (CPT)
- CPT Billing Code: 97112
- Insurance Median: $103
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 3.15x 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 315% of the Medicare baseline (a markup of 215%). 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 |
|---|---|---|
| Cigna | $41 - $125 | 125% |
| UnitedHealthcare | $42 - $124 | 128% |
| Aetna | $42 | 128% |
| Blue Cross Blue Shield | $80 - $117 | 244% |
| Medica | $172 | 526% |
Consumer Guidance & Cost Commentary
For the CPT code 97112, representing physical therapy neuromuscular re-education, the Kansas City Orthopaedic Institute in Leawood, KS, has a gross charge of $129.00. This facility is in-network for five major payers, including Cigna, UnitedHealthcare, Aetna, Blue Cross Blue Shield, and Medica, with negotiated rates ranging from $41 to $172 depending on the specific plan. The median negotiated rate across these payers is $103.00. When compared to the state average, this facility's rates are 3.1 times higher than the Medicare benchmark of $32.73. While commercial insurance contracts often result in higher out-of-pocket costs due to administrative overhead and network tiering, patients with high-deductible plans may find that paying the cash price directly is more economical, as the cash rate can sometimes be lower than the insurer's negotiated allowed amount.
To minimize costs, patients should proactively request "self-pay" or "prompt-pay" discounts before scheduling their visit, as these upfront payment incentives can significantly reduce the final bill by bypassing costly insurance claims processing. It is important to note that balance billing is generally prohibited for in-network services under federal protections, though patients should always verify their specific plan details to avoid unexpected charges. If a discrepancy arises, consumers should demand a full itemized billing audit rather than accepting a summary bill, as detailed line-item reviews are the most effective method for identifying errors such as unbundled codes or services not rendered. Always confirm your deductible status and ask for a written waiver of insurance submission if you intend to pay cash to ensure the facility