Physical therapy (neuromuscular re-education)
Facility: Ashland Health Center
Billing Code: 97112 (CPT)
- CPT Billing Code: 97112
- Insurance Median: $69
- Cash Discount Price: $55
- vs. Medicare Baseline: 2.11x 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 211% of the Medicare baseline (a markup of 111%). 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 | $23 | 70% |
| Compalliance-All Plans | $55 | 168% |
| Health Partners Of Kansas-All Plans | $59 | 180% |
| Multiplan-All Plans | $68 | 208% |
| UnitedHealthcare | $69 | 211% |
| Aetna | $69 | 211% |
| Medicare (plans) | $69 | 211% |
| Medica Mcare - All Plans | $69 | 211% |
| Medicaid / KanCare | $69 | 211% |
| Healthy Blue Mcr Adv - All Other Plans | $69 | 211% |
| Health Choice-All Plans | $69 | 211% |
| Providers Care (Wppa)-All Plans | $104 | 318% |
Consumer Guidance & Cost Commentary
For CPT code 97112, physical therapy (neuromuscular re-education), Ashland Health Center in Ashland, KS, lists a gross charge of $69.00. This amount represents the median negotiated rate across 12 payers, including Blue Cross Blue Shield, UnitedHealthcare, and Medicare. While the facility's cash median is $55.00, which is lower than the negotiated rate, patients should be aware that cash payments may not always be the cheapest option. If a patient has a high-deductible plan, their insurance might cover a larger portion of the $69.00 negotiated rate, potentially resulting in lower out-of-pocket costs than paying the full cash price upfront. Additionally, patients should explicitly ask the hospital about "self-pay" or "prompt-pay" discounts before scheduling, as these incentives can further reduce the final bill.
The pricing for this service is benchmarked against federal standards, with the Medicare amount set at $32.73. Commercial negotiated rates, such as the $69.00 seen here, typically average between 200% and 300% of the Medicare rate, reflecting the administrative costs and contract dynamics of commercial insurance. It is important to note that comparing the gross charge to the Medicare rate provides a clearer picture of the actual cost than looking at the hospital's inflated list price. For this specific service, the negotiated rate of $69.00 aligns with the median paid amount, indicating consistent pricing across the various insurance plans listed for this facility.