Physical therapy (neuromuscular re-education)
Facility: Clara Barton Hospital
Billing Code: 97112 (CPT)
- CPT Billing Code: 97112
- Insurance Median: $73
- Cash Discount Price: $63
- vs. Medicare Baseline: 2.23x 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 223% of the Medicare baseline (a markup of 123%). 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 | $50 | 153% |
| 6 Degrees Health - All Plans | $57 - $69 | 174% |
| Wppa-All Plans | $65 - $79 | 199% |
| Aetna | $73 - $89 | 223% |
| UnitedHealthcare | $73 - $89 | 223% |
| Phcs - All Plans | $73 - $89 | 223% |
| Hlth Partners Of Ks-All Plans | $75 - $91 | 229% |
Consumer Guidance & Cost Commentary
For the CPT code 97112, representing neuromuscular re-education physical therapy at Clara Barton Hospital in Hoisington, KS, the cash median price is $63.00, while the median negotiated rate across seven payers is $73.00. 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, a voluntary non-profit Critical Access Hospital, lists a cash median of $63.00 against a Medicare benchmark of $32.73, suggesting the cash rate is approximately 1.9 times the Medicare amount. Patients are encouraged to verify if their specific insurance plan has a negotiated rate lower than the cash price before scheduling, as administrative fees and claim processing can sometimes make the insurance route more expensive than self-pay.
The data shows that while the facility's cash median of $63.00 is lower than the gross charge of $90.00, the negotiated rates range from $50.00 to $91.00 depending on the payer. For instance, Blue Cross Blue Shield has a single plan with a negotiated rate of $50.00, which is significantly lower than the cash price, whereas some plans like those under Wppa-All Plans and Aetna have negotiated ranges starting at $65.00 and $73.00 respectively. To ensure you receive the best possible rate, patients should request a prompt-pay discount or self-pay classification before check-in, which can reduce the bill by 20% to 50