Physical therapy (neuromuscular re-education)
Facility: Lane County Hospital
Billing Code: 97112 (CPT)
- CPT Billing Code: 97112
- Insurance Median: $90
- Cash Discount Price: $90
- 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 |
|---|---|---|
| UnitedHealthcare | $81 - $90 | 247% |
| Aetna | $81 - $86 | 247% |
| Healthy Blue Mcr Adv - All Other Plans | $90 | 275% |
| Medicaid / KanCare | $90 - $99 | 275% |
| Healthy Blue Mcaid | $90 | 275% |
| Wppa Providers-All Plans | $135 | 412% |
Consumer Guidance & Cost Commentary
For the CPT code 97112, representing physical therapy neuromuscular re-education, Lane County Hospital in Dighton, KS, lists a cash median price of $90.00, which matches the facility's negotiated median and the gross charge. This rate is significantly higher than the Medicare benchmark of $32.73, indicating a markup of 2.7 times the federal baseline. While the facility is a Critical Access Hospital owned by a Government Hospital District, the data shows no specific county or state average provided for comparison. Patients should note that commercial payers like UnitedHealthcare and Aetna have negotiated rates ranging from $81 to $90, while Medicaid plans generally pay the full $90.00.
Because the cash price of $90.00 is lower than or equal to the negotiated rates for most commercial insurers, paying out-of-pocket may be the most cost-effective option for patients with high-deductible plans who have not yet met their coverage thresholds. To maximize savings, patients should explicitly ask the billing department about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront incentives can reduce the final bill by 20% to 50%. Additionally, since the No Surprises Act prohibits balance billing for out-of-network services at in-network facilities, patients can be confident that the $90.00 rate is the final amount owed for this service, provided they do not receive unexpected ancillary charges from out-of-network providers.