Physical therapy (neuromuscular re-education)
Facility: Nemaha Valley Community Hospital
Billing Code: 97112 (CPT)
- CPT Billing Code: 97112
- Insurance Median: $58
- Cash Discount Price: $104
- vs. Medicare Baseline: 1.77x 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 |
|---|---|---|
| Blue Cross Blue Shield | $50 | 153% |
| Humana | $51 | 156% |
| Va Ccn - All Plans | $51 | 156% |
| Aetna | $52 - $99 | 159% |
| Celtic Comm Exch - All Plans | $56 | 171% |
| Partners Direct Health - All Plans | $60 | 183% |
| Multiplan - All Plans | $104 | 318% |
| Health Partners - All Plans | $110 | 336% |
| Midlands Choice - All Plans | $110 | 336% |
Consumer Guidance & Cost Commentary
For the physical therapy service code 97112 at Nemaha Valley Community Hospital in Seneca, Kansas, the cash price is $104.00, which is notably higher than the state average of $60.00. While commercial insurance plans like Aetna and Multiplan have negotiated rates ranging from $50 to $110, these amounts often exceed the cash price, meaning patients with high-deductible plans might save money by paying the full cash rate of $104.00 directly rather than relying on insurance reimbursement. It is important to note that while the facility is a Critical Access Hospital with a voluntary non-profit ownership structure, patients should verify their specific plan's allowed amount before scheduling, as some in-network contracts may result in higher out-of-pocket costs than self-pay options.
Patients should be aware that the median negotiated payment across all payers is $58.00, which is lower than the cash price but still significantly higher than the Medicare benchmark of $32.73. This disparity highlights how commercial rates can be marked up relative to the federal baseline, and it underscores the value of requesting a prompt-pay discount if paying in full upfront. To avoid unexpected charges, consumers should ask the hospital specifically about self-pay or prompt-pay discounts before check-in and ensure they sign a waiver of insurance submission if they choose to pay cash directly. Additionally, if a balance bill arises from an out-of-network ancillary service, patients should dispute the amount with the insurer rather than paying immediately, as federal protections like the No Surprises Act may apply to prevent surprise costs.