Physical therapy (neuromuscular re-education)
Facility: Ellinwood District Hospital
Billing Code: 97112 (CPT)
- CPT Billing Code: 97112
- Insurance Median: $53
- Cash Discount Price: $64
- vs. Medicare Baseline: 1.62x 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 | $52 | 159% |
| Blue Cross Blue Shield | $52 | 159% |
| Humana | $52 | 159% |
| UnitedHealthcare | $52 | 159% |
| Cigna | $52 | 159% |
Consumer Guidance & Cost Commentary
For this Physical therapy (neuromuscular re-education) service at Ellinwood District Hospital, the negotiated rates across all five major payers are consistently $52.00, which aligns with the facility's median negotiated amount. This rate is significantly higher than the cash price of $64.00, meaning patients paying out-of-pocket may save money compared to using insurance, provided their plan allows for cash payment. While the facility is a Critical Access Hospital in Ellinwood, KS, the data does not include specific county or state average comparisons for this code, so the $52.00 negotiated rate should be viewed as the standard expected cost for in-network members.
The Medicare benchmark for this service is $32.73, indicating that the commercial negotiated rate of $52.00 represents a markup relative to the federal baseline. Patients should be aware that while the No Surprises Act protects against balance billing for out-of-network providers at in-network facilities, it does not apply to self-pay scenarios. To maximize savings, individuals should explicitly request a "self-pay" or "prompt-pay" discount before scheduling, as paying the bill upfront can often reduce the final amount further. It is also important to verify your deductible status, as paying the full negotiated rate may not be covered if your plan has not yet met your annual deductible.