Physical therapy (neuromuscular re-education)
Facility: Stafford County Hospital
Billing Code: 97112 (CPT)
- CPT Billing Code: 97112
- Insurance Median: $72
- Cash Discount Price: $74
- vs. Medicare Baseline: 2.20x 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 220% of the Medicare baseline (a markup of 120%). 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 |
|---|---|---|
| Health Partners-All Plans | $68 - $71 | 208% |
| UnitedHealthcare | $72 - $75 | 220% |
| Medica Mcr- All Plans | $72 - $75 | 220% |
| Humana | $72 - $75 | 220% |
| Va Ccn-All Plans | $72 - $75 | 220% |
Consumer Guidance & Cost Commentary
For the CPT code 97112, representing neuromuscular re-education physical therapy at Stafford County Hospital, the cash median price is $74.00, which aligns closely with the negotiated rates of $72.00 paid by major payers including UnitedHealthcare, Humana, and Medica Mcr. While the facility is a Critical Access Hospital in Kansas, the data provided does not include specific state or county average benchmarks for comparison. However, it is important to note that commercial negotiated rates often exceed cash prices due to administrative overhead and contract structures; in this case, the cash price is slightly higher than the negotiated amount, which can be advantageous for patients with high-deductible plans who may not yet have met their out-of-pocket maximum.
Patients should verify whether "self-pay" or "prompt-pay" discounts are available before scheduling, as paying upfront can sometimes bypass the administrative costs associated with insurance billing. Additionally, while the Medicare benchmark for this service is $32.73, commercial rates are significantly higher, reflecting the complexity of provider work and practice expenses. If you receive a bill, request a full itemized statement to ensure no errors exist, as over 80% of hospital bills contain discrepancies. Always confirm your deductible status and ensure the facility is correctly classified as self-pay to avoid automatic claims submission that could void potential cash discounts.