Physical therapy (neuromuscular re-education)
Facility: Cloud County Health Center
Billing Code: 97112 (CPT)
- CPT Billing Code: 97112
- Insurance Median: $112
- Cash Discount Price: $85
- vs. Medicare Baseline: 3.42x 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 342% of the Medicare baseline (a markup of 242%). 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 |
|---|---|---|
| Aetna | $96 - $128 | 293% |
| Health Partners - All Plans | $101 - $130 | 309% |
| Mpi-All Plans | $101 - $130 | 309% |
| Pponext-All Plans | $101 - $130 | 309% |
Consumer Guidance & Cost Commentary
For the CPT code 97112, representing neuromuscular re-education physical therapy, Cloud County Health Center in Concordia, KS, lists a cash median price of $85.00 and a negotiated median paid amount of $112.00. While the facility is a Critical Access Hospital with a voluntary non-profit ownership structure, the negotiated rate of $112.00 exceeds the cash price, which can be a critical consideration for patients with high-deductible plans. In such cases, paying the lower cash price of $85.00 upfront may result in significant savings compared to the insurance negotiated rate, provided the patient has not yet met their deductible. Patients should verify their specific plan's deductible status and explicitly request "self-pay" or "prompt-pay" discounts before scheduling services to ensure they are not charged the full negotiated amount.
It is important to understand that the $112.00 negotiated rate reflects the contractual ceiling set by insurance carriers rather than the facility's full chargemaster list price, which is often significantly higher. This structure protects in-network members from balance billing, as the No Surprises Act generally prevents providers from charging the difference between the allowed amount and the full list price for out-of-network services at in-network facilities. However, patients should always request a detailed, itemized bill to review specific CPT codes and avoid paying for services that were never rendered or that were incorrectly unbundled. By comparing the facility's rates against the Medicare benchmark of $32.73, consumers can see that the commercial negotiated rate represents a substantial markup, highlighting the value of securing the lowest possible cash or self-pay rate before treatment begins.