Physical therapy (neuromuscular re-education)
Facility: Great Plains Of Sabetha
Billing Code: 97112 (CPT)
- CPT Billing Code: 97112
- Insurance Median: $69
- Cash Discount Price: $85
- vs. Medicare Baseline: 2.11x 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 211% of the Medicare baseline (a markup of 111%). 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 |
|---|---|---|
| Celtic Mcr Adv | $36 - $52 | 110% |
| Aetna | $36 - $101 | 110% |
| Celtic Comm Exchange-All Other Plans | $45 - $65 | 137% |
| Great West Healthcare-All Plans | $59 - $85 | 180% |
| UnitedHealthcare | $64 - $100 | 196% |
| Humana | $66 - $95 | 202% |
| Cigna | $66 - $95 | 202% |
| Federated Mutual Ins-All Plans | $66 - $96 | 202% |
| Century/Wppa/Providers-All Plans | $66 - $95 | 202% |
| Multiplan-Phcs-All Plans | $66 - $95 | 202% |
| Medicaid / KanCare | $69 - $100 | 211% |
| Blue Cross Blue Shield | $69 - $100 | 211% |
Consumer Guidance & Cost Commentary
For the CPT code 97112, representing physical therapy neuromuscular re-education, Great Plains of Sabetha in Sabetha, KS, lists a cash median price of $85.00. This cash rate is notably higher than the state average of $66.00, which is also the median negotiated rate for this service across the state. While commercial payers like Aetna and UnitedHealthcare negotiate rates ranging from $36 to $101, patients with high-deductible plans may find the cash price more favorable if their insurance allowed amount exceeds $85.00. It is important to note that cash-pay can sometimes be cheaper for patients with high-deductible plans if the insurance negotiated rate exceeds the cash price, so verifying your specific plan's allowed amount before scheduling is essential.
Patients should be aware that commercial negotiated rates often include administrative overhead, which can inflate the baseline price by 20% to 40% compared to the true cost of care. In this case, the facility's gross charge is $85.00, while the Medicare benchmark is $32.73, indicating a significant markup relative to the federal government's cost-based reimbursement. To minimize costs, consumers should explicitly ask the hospital for "self-pay" or "prompt-pay" discounts before check-in, as these upfront payment incentives can bypass costly insurance billing cycles. Additionally, if you receive a bill from an out-of-network provider or encounter unexpected charges, you have the right to dispute the amount under federal protections like the No Surprises Act, ensuring you are not balance billed for services not covered by your plan.