Physical therapy (neuromuscular re-education)
Facility: Mercy Specialty Hospital Southeast Kansas
Billing Code: 97112 (CPT)
- CPT Billing Code: 97112
- Insurance Median: $63
- Cash Discount Price: $75
- vs. Medicare Baseline: 1.92x 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 |
|---|---|---|
| First Health Contracted [320128] | $24 | 73% |
| Aetna | $24 - $30 | 73% |
| Blue Cross Blue Shield | $27 - $37 | 82% |
| Medicaid / KanCare | $27 - $30 | 82% |
| UnitedHealthcare | $28 - $106 | 86% |
| Qual Choice Contracted [320325] | $30 | 92% |
| Tricare | $30 | 92% |
| Dept Of Veteran Affairs Contracted [320106] | $30 | 92% |
| Medical Associates Health Contracted [320444] | $30 | 92% |
| Halo Hcr Inc Hospice Contracted [320432] | $30 | 92% |
| Cigna | $30 - $89 | 92% |
| Mercy Hospice Okc [20252] | $30 | 92% |
| Pace Of The Ozarks Contracted [320518] | $30 | 92% |
| Kindful Hospice [20434] | $30 | 92% |
| Humana | $30 | 92% |
| Medicare (plans) | $30 | 92% |
| Elara Caring Aspire Hospice [20433] | $30 | 92% |
| Mercy Mgd Behavioral Health Contracted [320259] | $30 | 92% |
| Cross Timbers Hospice [20098] | $30 | 92% |
| Globalhealth Contracted [320145] | $30 | 92% |
| Kindful Hospice Contracted [320434] | $30 | 92% |
| Halo Hcr Inc Hospice [20432] | $30 | 92% |
| Centivo Contracted [320505] | $30 | 92% |
| Cherokee Nation Health Serv Contracted [320066] | $30 | 92% |
| Provider Partners Health Plans Contracted [320450] | $32 | 98% |
| Medica Contracted [320239] | $42 | 128% |
| Providrs Care Network Contracted [320484] | $58 | 177% |
| Point C Contracted [320238] | $58 - $86 | 177% |
| Show-Me Health Administrators Contracted [320483] | $69 | 211% |
| Mercy Benefit Admin Contracted [320251] | $69 - $80 | 211% |
| Ebms Contracted [320493] | $80 | 244% |
| Yuzu Health Contracted [320521] | $80 | 244% |
| Imagine 360 Contracted [320494] | $80 | 244% |
| American Healthcare Alliance Contracted [320020] | $80 | 244% |
| Edison Health Solutions Contracted [320502] | $80 | 244% |
| Aither Health Contracted [320449] | $80 | 244% |
| Reflect Health Contracted [320492] | $80 | 244% |
| Auxiant Contracted [320462] | $80 - $86 | 244% |
| Healthlink Contracted [320179] | $86 | 263% |
| Healthscope Contracted [320182] | $86 | 263% |
| Health Systems Inc Contracted [320174] | $86 | 263% |
| Federal Medical Center Contracted [320127] | $86 | 263% |
| Preferred Health Plan Contracted [320522] | $86 | 263% |
| Benefit Management Contracted [320052] | $86 | 263% |
| United Medical Resources Contracted [320454] | $86 - $102 | 263% |
| Insurance System Inc Contracted [320465] | $86 | 263% |
| Compcare Of The Ozarks Contracted [320437] | $91 | 278% |
| Workers Comp [20426] | $92 | 281% |
| Private Health Care Systems Contracted [320320] | $106 | 324% |
| Multiplan Contracted [320270] | $109 | 333% |
| Multiplan [20270] | $109 | 333% |
Consumer Guidance & Cost Commentary
For the Physical therapy (neuromuscular re-education) service at Mercy Specialty Hospital Southeast Kansas, the facility's cash price of $75.00 is notably higher than the state average cash median of $35.00. While many commercial payers have negotiated rates ranging from $24 to $106, the cash rate remains a significant benchmark for patients without insurance. It is important to note that for individuals with high-deductible plans, paying the cash price upfront can sometimes be more cost-effective than using insurance, as the negotiated rates paid by insurers often exceed the cash price. Patients should proactively ask the hospital about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront payment incentives can reduce the final bill by 20% to 50% by bypassing costly claims processing and administrative overhead.
When using insurance, the facility's negotiated rates vary widely across different plans, with the lowest allowed amount being $24 and the highest reaching $109. The median negotiated rate across all payers is $63.00, which is higher than the facility's cash price but lower than the gross charge of $115.00. To ensure you are receiving fair value, it is recommended to compare these negotiated amounts directly against the Medicare benchmarking rate of $32.73 for this procedure. Since Medicare rates represent a scientifically validated cost baseline, commercial rates that are significantly higher may indicate a markup that could be reduced through negotiation or by seeking alternative in-network providers. Always verify your specific plan's allowed amount before treatment to avoid unexpected balance billing or out-of-pocket costs.