Physical therapy (neuromuscular re-education)
Facility: Stevens County Hospital
Billing Code: 97112 (CPT)
- CPT Billing Code: 97112
- Insurance Median: $77
- Cash Discount Price: $88
- vs. Medicare Baseline: 2.35x 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 235% of the Medicare baseline (a markup of 135%). 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 |
|---|---|---|
| Humana | $33 | 101% |
| Aetna | $34 - $88 | 104% |
| Blue Cross Blue Shield | $48 - $50 | 147% |
| First Health - All Plans | $79 | 241% |
| Wppa - All Plans | $84 | 257% |
| Medicaid / KanCare | $88 | 269% |
Consumer Guidance & Cost Commentary
For the CPT code 97112, representing physical therapy for neuromuscular re-education, Stevens County Hospital in Hugoton, KS, lists a cash median price of $88.00. This cash rate is notably higher than the facility's median negotiated rate of $77.00, which reflects the contractual agreements with insurance carriers like Aetna and Blue Cross Blue Shield. While commercial insurance plans typically pay negotiated rates that include administrative overhead, patients with high-deductible plans may find the cash price more advantageous if the insurance allowed amount exceeds $88.00. It is important to note that the facility's negotiated rate of $77.00 is significantly lower than the Medicare benchmark of $32.73, suggesting a markup relative to the federal baseline, though commercial rates often exceed Medicare by a wider margin due to network tiering and contract dynamics.
Consumers should be aware that assuming in-network status guarantees the lowest possible price is a common pitfall, as different payers within the same network may have varying allowed amounts. For this service, the lowest negotiated rate observed is $33.00 with Humana, while the highest is $88.00 with Medicaid/KanCare, highlighting significant variation even among insurers. Patients are encouraged to verify their specific plan's allowed amount before scheduling to ensure they are not facing unexpected costs. Additionally, since the facility is a Critical Access Hospital with government local ownership, patients should explicitly ask about self-pay or prompt-pay discounts, which can reduce bills by 20% to 50% if paid upfront, bypassing the administrative costs associated with insurance claims processing.