Physical therapy (neuromuscular re-education)
Facility: Wichita County Health Center
Billing Code: 97112 (CPT)
- CPT Billing Code: 97112
- Insurance Median: $65
- Cash Discount Price: $57
- vs. Medicare Baseline: 1.99x 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 |
|---|---|---|
| Medicaid / KanCare | $54 - $64 | 165% |
| UnitedHealthcare | $65 - $78 | 199% |
Consumer Guidance & Cost Commentary
For this Physical therapy (neuromuscular re-education) service, the facility's cash median rate of $57.00 is lower than the negotiated rates paid by UnitedHealthcare ($65.00 to $78.00) and Medicaid/KanCare ($54.00 to $64.00). While the cash price is generally more affordable for patients without insurance, it is important to note that commercial insurance often covers a significant portion of the cost. The negotiated rate for UnitedHealthcare, for instance, averages $71.50, which is higher than the cash price, meaning patients with high-deductible plans might save money by paying the cash rate directly, provided they qualify for the facility's self-pay or prompt-pay discounts. Always verify the specific "self-pay" or "prompt-pay" rates with the hospital before scheduling, as these upfront discounts can further reduce the final amount owed.
The Medicare benchmark for this procedure is $32.73, which serves as the objective baseline for evaluating pricing fairness. The facility's cash rate of $57.00 represents a markup of approximately 74% over the Medicare amount, while the negotiated rate for UnitedHealthcare exceeds the Medicare benchmark by roughly 123%. This comparison highlights that the commercial negotiated rate is significantly higher than the federal cost baseline, reflecting the administrative costs and contract dynamics inherent in insurance billing. To ensure you are not overcharged, we recommend requesting an itemized billing audit to review the specific CPT codes and unit costs, as over 80% of hospital bills contain errors such as double-billing or unbundled charges that can be corrected to lower your final bill