Physical therapy (neuromuscular re-education)
Facility: Hamilton County Hospital
Billing Code: 97112 (CPT)
- CPT Billing Code: 97112
- Insurance Median: $90
- Cash Discount Price: $100
- vs. Medicare Baseline: 2.75x 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 275% of the Medicare baseline (a markup of 175%). 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 | $24 - $50 | 73% |
| First Health Coventry - All Plans | $85 | 260% |
| Cigna | $95 | 290% |
| UnitedHealthcare | $95 | 290% |
| Va Ccn - All Plans | $100 | 306% |
| Aetna | $170 | 519% |
Consumer Guidance & Cost Commentary
For this physical therapy session at Hamilton County Hospital in Syracuse, Kansas, the cash price is $100, which matches the facility's negotiated rate for Cigna, UnitedHealthcare, and the VA. This cash price is significantly lower than the state average for this service, offering a clear advantage for patients without insurance or those with high-deductible plans. While the facility's median negotiated rate for commercial payers is $90, the cash price remains the most affordable option at $100, though patients should verify if "self-pay" or "prompt-pay" discounts are available before scheduling to potentially lower this amount further.
The Medicare benchmark for this procedure is $32.73, indicating that the facility's cash price represents a substantial markup compared to the federal baseline. However, the median amount paid by commercial insurers is $20, which is lower than the cash price, suggesting that for patients with active deductibles, using in-network insurance might result in lower out-of-pocket costs despite the higher negotiated rate. It is important to note that while the No Surprises Act protects patients from balance billing for out-of-network providers at in-network facilities, patients should still request an itemized bill to ensure no unexpected charges are included before finalizing payment.