Physical therapy (neuromuscular re-education)
Facility: Rooks County Health Center
Billing Code: 97112 (CPT)
- CPT Billing Code: 97112
- Insurance Median: $94
- Cash Discount Price: $78
- vs. Medicare Baseline: 2.87x 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 287% of the Medicare baseline (a markup of 187%). 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 |
|---|---|---|
| Veterans Admin - All Plans | $49 | 150% |
| Celtic Mcr Adv | $49 | 150% |
| Tricare | $49 | 150% |
| Blue Cross Blue Shield | $50 | 153% |
| Celtic Comm - All Other Plans | $54 | 165% |
| Preferred Benefits Admin | $94 | 287% |
| UnitedHealthcare | $94 | 287% |
| Aetna | $94 | 287% |
| Health Partners - All Plans | $99 | 302% |
| Preferred Hlthcare - All Other Plans | $99 | 302% |
| Healthy Blue Mcaid - All Plans | $104 | 318% |
Consumer Guidance & Cost Commentary
For the CPT code 97112, representing neuromuscular re-education physical therapy, the gross charge at Rooks County Health Center in Plainville, KS is $105.00. This facility, a Critical Access Hospital owned by a Government Hospital District, has negotiated rates ranging from $49.00 to $104.00 across 11 payers, with a median negotiated amount of $94.00. The cash price for this service is $78.00, which is notably lower than the median negotiated rate of $94.00. While the facility's cash price is not explicitly compared to a county or state average in the provided data, patients should be aware that paying cash upfront can sometimes result in lower out-of-pocket costs than using insurance, particularly if their plan has a high deductible or if the insurer's negotiated rate exceeds the cash price.
To minimize costs, patients should verify their specific plan's allowed amount before scheduling and ask the billing department about "self-pay" or "prompt-pay" discounts, which can range from 20% to 50% for upfront payments. It is important to avoid balance billing by ensuring the provider is in-network, as the No Surprises Act protects patients from unexpected bills for out-of-network services at in-network facilities. Additionally, since over 80% of hospital bills contain errors, patients should request a detailed, itemized bill to review specific CPT codes and identify any unbundled charges or services not rendered. For context on fair pricing, the Medicare amount for this code is $32.73, which serves as a baseline; commercial negotiated rates often exceed