Physical therapy (neuromuscular re-education)
Facility: Hospital District #6 Patterson Health Center
Billing Code: 97112 (CPT)
- CPT Billing Code: 97112
- Insurance Median: $77
- Cash Discount Price: $68
- 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 |
|---|---|---|
| Blue Cross Blue Shield | $48 - $50 | 147% |
| UnitedHealthcare | $76 - $85 | 232% |
| Providers Care (Wppa)-All Plans | $149 | 455% |
Consumer Guidance & Cost Commentary
For the CPT code 97112, representing physical therapy neuromuscular re-education, the facility's cash median rate is $68.00, while the negotiated rates for in-network payers like Blue Cross Blue Shield and UnitedHealthcare range from $48 to $85. It is important to note that commercial negotiated rates often exceed cash prices due to administrative overhead and contract structures; therefore, patients with high-deductible plans may find paying the cash price of $68.00 more cost-effective than relying on insurance, which could result in a higher allowed amount. Additionally, patients should verify if the facility offers self-pay or prompt-pay discounts, as paying the bill in full upfront can sometimes reduce the final amount owed by bypassing costly claims processing fees.
When evaluating the cost relative to government benchmarks, the Medicare amount for this service is $32.73. Commercial rates, including the negotiated averages of $77.00, typically fall between 200% and 300% of the Medicare rate, whereas fair pricing is generally defined as 120% to 150% of this baseline. While the data provided does not include specific state or county average comparisons for this code, the facility is a Critical Access Hospital in Anthony, KS, and patients should be aware that balance billing is largely prohibited for emergency care and non-emergency services at in-network facilities under federal law. To ensure accuracy, consumers are encouraged to request an itemized billing audit to identify any errors, unbundled codes, or services not rendered before finalizing payment.