Physical therapy (neuromuscular re-education)
Facility: Grisell Memorial Hospital
Billing Code: 97112 (CPT)
- CPT Billing Code: 97112
- Insurance Median: $77
- Cash Discount Price: $84
- vs. Medicare Baseline: 2.35x 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 235% of the Medicare baseline (a markup of 135%). 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 |
|---|---|---|
| Blue Cross Blue Shield | $48 | 147% |
| UnitedHealthcare | $66 - $89 | 202% |
| Medicaid / KanCare | $89 | 272% |
| Humana | $89 | 272% |
Consumer Guidance & Cost Commentary
For the CPT code 97112, representing physical therapy for neuromuscular re-education, Grisell Memorial Hospital in Ransom, KS, lists a gross charge of $89.00. While the facility's cash median is $84.00, the median amount paid by insurance is $89.00, which matches the gross charge. It is important to note that commercial negotiated rates often exceed cash prices due to administrative costs and contract structures; in this case, the median negotiated rate is $77.00, which is lower than the gross but still higher than the cash option. Patients with high-deductible plans may find paying the cash price of $84.00 more cost-effective than relying on insurance, as the insurer's allowed amount could result in out-of-pocket costs that exceed the cash rate. Additionally, patients should verify if the facility offers "self-pay" or "prompt-pay" discounts, which can provide further fee reductions for upfront payment.
When evaluating this rate against benchmarks, the Medicare amount for this service is $32.73. The facility's gross charge of $89.00 represents a significant markup relative to the Medicare baseline, illustrating how commercial rates can differ substantially from the federal cost basis. While specific county or state average comparisons are not provided in the current data, understanding the Medicare rate helps establish a scientifically validated baseline for assessing pricing fairness. To ensure you are receiving the best possible rate, it is recommended to request an itemized billing audit to confirm all charges are accurate and to inquire directly about any available prompt-pay discounts before scheduling your visit.