Physical therapy (neuromuscular re-education)
Facility: Sheridan County Hospital
Billing Code: 97112 (CPT)
- CPT Billing Code: 97112
- Insurance Median: $70
- Cash Discount Price: $100
- vs. Medicare Baseline: 2.14x 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 214% of the Medicare baseline (a markup of 114%). 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 Insurance | $60 | 183% |
| Blue Cross Blue Shield | $70 | 214% |
| UnitedHealthcare | $95 | 290% |
Consumer Guidance & Cost Commentary
For this Physical therapy (neuromuscular re-education) service at Sheridan County Hospital in Hoxie, KS, the cash price is $100.00, which matches the facility's cash median. While the hospital is a Critical Access Hospital owned by the local government, the negotiated rates for in-network payers like Celtic Insurance ($60), Blue Cross Blue Shield ($70), and UnitedHealthcare ($95) are lower than the cash price. This demonstrates a common billing dynamic where paying out-of-pocket can sometimes be more expensive than using insurance, even if the patient has not yet met their deductible. Because the negotiated rates are capped by insurance contracts, patients should verify their specific plan's allowed amount before scheduling to ensure they are not paying the full $100.00.
The facility's pricing is also evaluated against Medicare benchmarks, where the Medicare rate for this code is $32.73. The facility's cash price of $100.00 represents a 2.1x markup over the Medicare rate, which is significantly higher than the typical fair pricing range of 120% to 150% of Medicare. To minimize costs, patients should explicitly ask the hospital about "self-pay" or "prompt-pay" discounts, which can reduce the bill by 20% to 50% if paid in full upfront. Additionally, if a patient receives a surprise bill after insurance processing, they should request an itemized audit to identify any unbundled codes or services not rendered, as over 80% of hospital bills contain errors that can be corrected through formal written disputes.