Physical therapy (neuromuscular re-education)
Facility: Wilson Medical Center
Billing Code: 97112 (CPT)
- CPT Billing Code: 97112
- Insurance Median: $90
- Cash Discount Price: $85
- vs. Medicare Baseline: 2.75x 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 275% of the Medicare baseline (a markup of 175%). 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 - $113 | 153% |
| UnitedHealthcare | $60 - $105 | 183% |
| Aetna | $60 - $113 | 183% |
| Tricare | $60 | 183% |
| Humana | $60 | 183% |
| Ambetter / Centene | $60 - $113 | 183% |
| Cigna | $90 | 275% |
| Health Partners-All Plans | $104 | 318% |
| Mulitplan-All Plans | $104 | 318% |
Consumer Guidance & Cost Commentary
For CPT code 97112, Physical therapy (neuromuscular re-education), Wilson Medical Center in Neodesha, KS, lists a gross charge of $113.00. While the facility's cash median rate is $85.00, which is lower than the gross charge, the negotiated rates for in-network payers range from $60.00 to $113.00, with most plans falling between $60.00 and $105.00. It is important to note that for patients with high-deductible plans, paying the cash price of $85.00 upfront can sometimes result in lower out-of-pocket costs compared to the negotiated rates their insurance would allow, which often exceed the cash price. Additionally, patients should inquire about "self-pay" or "prompt-pay" discounts, which can reduce the final bill by 20% to 50% if paid in full within a short window, bypassing the administrative costs associated with insurance claims processing.
The facility's negotiated rate of $90.00 is significantly higher than the Medicare benchmark of $32.73, reflecting a markup common in commercial billing structures where administrative overhead and contract dynamics inflate prices. While the facility is a Critical Access Hospital owned by the Government - Local, the specific code does not provide a direct comparison to state or county averages in the available data. Patients should be aware that balance billing is generally prohibited for emergency care and non-emergency services at in-network facilities under the No Surprises Act, but they should always request an itemized bill to verify that all charges are accurate and that no unbundled codes