Physical therapy (neuromuscular re-education)
Facility: Stanton County Hospital
Billing Code: 97112 (CPT)
- CPT Billing Code: 97112
- Insurance Median: $110
- Cash Discount Price: $116
- vs. Medicare Baseline: 3.36x 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 336% of the Medicare baseline (a markup of 236%). 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 | $48 - $110 | 147% |
| Healthy Blue Mcr Adv - All Other Plans | $113 | 345% |
| Healthy Blue Mcaid | $116 | 354% |
Consumer Guidance & Cost Commentary
For this physical therapy service at Stanton County Hospital in Johnson, KS, the cash price of $116.00 is significantly lower than the negotiated rates charged to most insurance plans. While Blue Cross Blue Shield pays an average of $110.00 and Healthy Blue plans pay the full $116.00, patients with high-deductible plans may find paying cash directly more affordable than relying on insurance, which often results in higher out-of-pocket costs due to deductibles and co-pays. The facility offers a prompt-pay discount for upfront payments, which can further reduce the final amount owed, so it is advisable to ask the billing department about self-pay rates before scheduling any appointments.
When evaluating the value of this care, it is important to compare the facility's pricing against the Medicare benchmark rather than the hospital's full chargemaster list. The Medicare reimbursement rate for this code is $32.73, which serves as the objective baseline for fair pricing; commercial negotiated rates typically range from 200% to 300% of this amount, while fair market pricing is generally considered to be between 120% and 150%. Although the data does not provide specific county or state average comparisons for this exact procedure, patients should be aware that the No Surprises Act protects them from balance billing for out-of-network services at in-network facilities, and they should always request an itemized bill to ensure no errors or unbundled charges are included in their final invoice.