Physical therapy (neuromuscular re-education)
Facility: Graham County Hospital
Billing Code: 97112 (CPT)
- CPT Billing Code: 97112
- Insurance Median: $62
- Cash Discount Price: $80
- vs. Medicare Baseline: 1.89x 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 |
|---|---|---|
| UnitedHealthcare | $43 - $76 | 131% |
| Medicaid / KanCare | $43 | 131% |
| Blue Cross Blue Shield | $50 | 153% |
| Medicare (plans) | $60 | 183% |
| Celtic Commercial-All Other Plans | $66 | 202% |
| Wppa (Providers Care)-All Plans | $76 | 232% |
Consumer Guidance & Cost Commentary
For the CPT code 97112, Physical therapy (neuromuscular re-education), Graham County Hospital in Hill City, KS, lists a cash price of $80.00, which matches the facility's median negotiated rate. This cash price is notably higher than the state average for this service, which is $66.00. While the facility is a Critical Access Hospital owned by the local government, patients should be aware that paying out-of-pocket can sometimes be more expensive than using insurance if the insurer's negotiated rate exceeds the cash price. However, because the cash price here is already at the median negotiated level, patients with high-deductible plans may find that paying the full $80.00 upfront avoids potential balance billing, especially if their insurance allows a lower amount than the chargemaster. It is always advisable to contact the hospital directly to confirm if "self-pay" or "prompt-pay" discounts are available before scheduling care.
The facility's billing structure relies on a mix of payer contracts, with rates ranging from $43 for Medicaid/KanCare to $76 for UnitedHealthcare. Medicare allows $32.73 for this service, which serves as a benchmark for fair pricing; commercial rates are often significantly higher due to administrative costs and contract dynamics. If a patient receives care from an out-of-network provider at this facility, they could face balance billing for the difference between the allowed amount and the full charge, though the No Surprises Act protects against this for emergency and non-emergency services at in-network facilities. To ensure accuracy, patients should request a full itemized bill rather than accepting a summary invoice, as hospitals may bundle services or charge for