Physical therapy (neuromuscular re-education)
Facility: Medicine Lodge Memorial Hospital
Billing Code: 97112 (CPT)
- CPT Billing Code: 97112
- Insurance Median: $63
- Cash Discount Price: $66
- vs. Medicare Baseline: 1.92x 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 |
|---|---|---|
| Tricare | $53 | 162% |
| Humana | $60 | 183% |
| Aetna | $61 - $66 | 186% |
| UnitedHealthcare | $63 | 192% |
| Hpk-All Plans | $63 | 192% |
| Medicaid / KanCare | $66 | 202% |
Consumer Guidance & Cost Commentary
For the CPT code 97112, representing neuromuscular re-education physical therapy at Medicine Lodge Memorial Hospital, the cash price is $66.00, which matches the facility's negotiated median rate of $63.00 and the cash median. This rate is significantly higher than the Medicare benchmark of $32.73, reflecting a markup common in commercial pricing where negotiated rates often average 200% to 300% of Medicare. While the data does not provide specific county or state average comparisons for this procedure, patients should note that cash-paying can sometimes be more cost-effective than using insurance if their plan's negotiated allowed amount exceeds the cash price, though this specific code shows the cash price is already at the negotiated floor.
Patients should be aware that while the No Surprises Act protects against balance billing for out-of-network providers at in-network facilities, it does not apply to self-pay scenarios. To minimize costs, individuals should explicitly ask the hospital about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront payment incentives can reduce the bill by 20% to 50% by bypassing administrative claim processing fees. If a patient receives a bill, they should request a full itemized statement to verify that no unbundled codes or services not rendered are included, as over 80% of hospital bills contain errors that can be disputed in writing to reduce medical debt.