Physical therapy (neuromuscular re-education)
Facility: Ellsworth County Medical Center
Billing Code: 97112 (CPT)
- CPT Billing Code: 97112
- Insurance Median: $70
- Cash Discount Price: $78
- vs. Medicare Baseline: 2.14x 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 214% of the Medicare baseline (a markup of 114%). 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 |
|---|---|---|
| Healthy Blue Mcr Adv | $37 | 113% |
| Triwest -All Plans | $37 | 113% |
| Va Ccn-All Plans | $37 | 113% |
| Humana | $37 - $74 | 113% |
| Blue Cross Blue Shield | $48 - $50 | 147% |
| UnitedHealthcare | $51 - $78 | 156% |
| Aetna | $70 | 214% |
| First Health - All Plans | $70 | 214% |
| Cigna | $74 | 226% |
| Coventry Mcaid-All Plans | $78 | 238% |
| Healthy Blue Mcaid- All Other Plans | $78 | 238% |
| Medicaid / KanCare | $78 | 238% |
| Providers Care-Wppa-All Plans | $117 | 357% |
Consumer Guidance & Cost Commentary
For the CPT code 97112, representing neuromuscular re-education physical therapy at Ellsworth County Medical Center, the cash median price is $78.00. This cash rate is significantly lower than the negotiated rates paid by most commercial payers, which range from $37 to $117 depending on the insurance plan. For instance, while Healthy Blue Mcr Adv and Triwest -All Plans pay exactly $37, UnitedHealthcare plans pay between $51 and $78, and Providers Care-Wppa-All Plans pay $117. Patients with high-deductible plans may find paying the $78 cash price directly more cost-effective than relying on insurance, as the negotiated rates often exceed the cash amount. It is important to note that the facility's cash rate aligns with the gross charge of $78.00, meaning no additional balance billing would occur if the patient pays the cash price directly.
The facility's pricing is benchmarked against the Medicare rate of $32.73, which serves as the objective baseline for healthcare costs. The cash price of $78.00 represents a markup of 2.1 times the Medicare amount, which is consistent with commercial pricing structures that include administrative overhead and profit margins. While the facility is a Critical Access Hospital in Ellsworth, KS, with a facility rating of 2, patients should be aware that commercial negotiated rates can vary widely; for example, Medicaid / KanCare pays $78, matching the cash price, whereas some private payers pay significantly less. To maximize savings, patients should request a prompt-pay discount before scheduling, which can reduce the $78