Physical therapy (neuromuscular re-education)
Facility: Holton Community Hospital
Billing Code: 97112 (CPT)
- CPT Billing Code: 97112
- Insurance Median: $69
- Cash Discount Price: $62
- 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 |
|---|---|---|
| Aetna | $44 - $83 | 134% |
| UnitedHealthcare | $44 - $100 | 134% |
| Humana | $45 | 137% |
| Kansas Superior Select - All Plans | $45 | 137% |
| Blue Cross Blue Shield | $50 | 153% |
| Preferred Health Fn Select - All Other Plans | $69 | 211% |
| Preferred Health Freedom | $69 | 211% |
| Preferred Health Professionals | $69 | 211% |
| Wppa Providers - All Plans | $79 | 241% |
| Medicaid / KanCare | $83 | 254% |
Consumer Guidance & Cost Commentary
For the CPT code 97112, representing physical therapy neuromuscular re-education, Holton Community Hospital lists a gross charge of $83.00. While the facility's cash median price is $62.00, which is lower than the negotiated rates paid by most insurance plans, patients should be aware that commercial insurance often results in higher out-of-pocket costs due to administrative fees and contract structures. The negotiated rates for this service range from $44 to $100 across ten different payers, with many plans settling at the full gross amount of $83.00. Because the cash price is significantly lower than the typical insurance allowed amount, patients with high-deductible plans may find it financially advantageous to pay the cash rate directly, provided they confirm with the hospital that no additional balance billing will occur.
To ensure you receive the most accurate pricing, it is recommended to request a prompt-pay discount or self-pay rate before scheduling your visit, as these upfront payments can reduce the total cost. If you do use insurance, be prepared to review your itemized bill carefully, as over 80% of hospital bills contain errors such as unbundled codes or services not rendered. If you receive a surprise bill that exceeds your insurance allowance, you may be eligible for protections under the No Surprises Act, which prohibits balance billing for emergency care and non-emergency services at in-network facilities. Always verify your specific deductible status and ask the billing department to confirm whether the cash rate or your insurance negotiated rate is more beneficial for your situation.