Physical therapy (neuromuscular re-education)
Facility: Decatur Health
Billing Code: 97112 (CPT)
- CPT Billing Code: 97112
- Insurance Median: $90
- Cash Discount Price: $103
- 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 |
|---|---|---|
| Wppa/Providrs Care- All Plans | $60 - $77 | 183% |
| UnitedHealthcare | $61 - $98 | 186% |
| Humana | $62 - $79 | 189% |
| Blue Cross Blue Shield | $65 | 199% |
| Midlands Choice- All Plans | $90 - $115 | 275% |
| Aetna | $90 - $128 | 275% |
| Medicaid / KanCare | $101 - $129 | 309% |
Consumer Guidance & Cost Commentary
For this Physical therapy (neuromuscular re-education) service at Decatur Health in Oberlin, KS, the cash price is $103.00, which is lower than the negotiated rates paid by most major insurers. While the facility's cash rate is $103.00, the median negotiated amount across payers is $90.00, meaning insurance plans typically pay less than the cash price. This is a common scenario where patients with high-deductible plans might save money by paying the cash price directly, as the insurance allowed amount often exceeds the cash rate. To maximize savings, patients should explicitly ask the hospital for "self-pay" or "prompt-pay" discounts before scheduling, as these upfront fee reductions can further lower the final cost.
The facility's pricing is evaluated against federal benchmarks to ensure transparency. The Medicare amount for this code is $32.73, and the facility's cash price of $103.00 represents a markup of 2.7 times the Medicare rate. It is important to note that commercial negotiated rates often include administrative overhead and contract dynamics that can inflate the baseline price. If you receive a bill from an out-of-network provider or encounter unexpected charges, you may be subject to balance billing, where the provider bills you for the difference between their full charge and what your insurance paid. To protect yourself, always request a detailed, itemized bill to verify that no services were double-billed or unbundled, and dispute any surprise charges in writing rather than accepting summary invoices.