Physical therapy (neuromuscular re-education)
Facility: Kiowa District Hospital
Billing Code: 97112 (CPT)
- CPT Billing Code: 97112
- Insurance Median: $94
- Cash Discount Price: $79
- vs. Medicare Baseline: 2.87x 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 287% of the Medicare baseline (a markup of 187%). 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 |
|---|---|---|
| Tricare | $39 | 119% |
| Blue Cross Blue Shield | $50 | 153% |
| Healthchoice-All Plans | $53 | 162% |
| UnitedHealthcare | $79 - $99 | 241% |
| Health Partners Of Ks-All Plans | $87 | 266% |
| Humana | $89 | 272% |
| Gbs Insurance - All Plans | $93 | 284% |
| Multiplan-All Plans | $93 | 284% |
| Aetna | $94 | 287% |
| Medicare (plans) | $94 | 287% |
| Triwest-All Plans | $94 | 287% |
| Medicaid / KanCare | $99 | 302% |
| Providers Care (Wppa)-All Plans | $148 | 452% |
| Liberty Healthshare-All Plans | $160 | 489% |
Consumer Guidance & Cost Commentary
For the CPT code 97112, representing neuromuscular re-education physical therapy at Kiowa District Hospital, the facility's cash median rate is $79.00, while the median negotiated rate across payers is $94.00. This indicates that for patients with high-deductible plans, paying cash directly may result in lower out-of-pocket costs compared to using insurance, as the negotiated rates often exceed the cash price. The facility is a Critical Access Hospital in Kiowa, Kansas, and while specific county or state average data is not provided in this report, the cash rate of $79.00 serves as a baseline for self-pay patients. It is important to note that commercial payers like UnitedHealthcare and Providers Care have negotiated ranges extending up to $160, which can significantly increase costs if a patient's deductible has not been met.
Patients should be aware that while the No Surprises Act protects against balance billing for emergency care and non-emergency services from out-of-network providers at in-network facilities, unexpected charges can still occur if ancillary services are billed separately. To avoid these surprises, consumers should request a full itemized bill before paying, ensuring no unbundled codes or services not rendered are included. Additionally, since prompt-pay discounts are often available for upfront payment, patients should explicitly ask the hospital about self-pay or prompt-pay rates prior to scheduling services to potentially reduce the final amount owed.