Physical therapy (neuromuscular re-education)
Facility: Kearny County Hospital
Billing Code: 97112 (CPT)
- CPT Billing Code: 97112
- Insurance Median: $188
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 5.74x 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 574% of the Medicare baseline (a markup of 474%). 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 | $94 | 287% |
| Wps Gha - Mac J5 Part A | $188 - $282 | 574% |
Consumer Guidance & Cost Commentary
For the CPT code 97112, representing neuromuscular re-education physical therapy, the facility in Lakin, KS, has a negotiated median paid amount of $94.00, which is 5.7% higher than the Medicare benchmark of $32.73. While the facility is a Critical Access Hospital with government local ownership, the data indicates a cash median price is not available for this service. Patients should be aware that commercial insurance contracts often result in higher allowed amounts than cash prices; however, since no cash rate is listed here, the negotiated rate of $94.00 serves as the primary benchmark for in-network coverage. It is important to note that while commercial rates can sometimes exceed cash prices, the absence of a listed cash median suggests that self-pay discounts or prompt-pay incentives should be verified directly with the hospital before scheduling, as these programs can significantly reduce out-of-pocket costs for those without insurance or with high-deductible plans.
This service is covered by two payers, including Blue Cross Blue Shield and Wps Gha - Mac J5 Part A, with negotiated rates ranging from $94 to $282 depending on the specific plan. Because the facility is out-of-network for some commercial payers or may involve out-of-network ancillary services like emergency physicians or labs, patients face the risk of balance billing if they do not have a contract in place. Under the No Surprises Act, balance billing is generally prohibited for emergency care and non-emergency services at in-network facilities, but patients should still request an itemized billing audit to ensure no unbundled codes or services not rendered are included on their final statement. To avoid unexpected charges