Physical therapy (neuromuscular re-education)
Facility: Phillips County Hospital
Billing Code: 97112 (CPT)
- CPT Billing Code: 97112
- Insurance Median: $68
- Cash Discount Price: $59
- vs. Medicare Baseline: 2.08x 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 208% of the Medicare baseline (a markup of 108%). 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 - $57 | 153% |
| UnitedHealthcare | $54 - $70 | 165% |
| Health Partners-All Plans | $68 - $70 | 208% |
| Medicaid / KanCare | $68 - $70 | 208% |
Consumer Guidance & Cost Commentary
For this Physical therapy (neuromuscular re-education) service at Phillips County Hospital in Phillipsburg, KS, the cash median price is $59.00, which is lower than the facility's negotiated rates of $68.00 and the gross charge of $69.00. While the facility is a Critical Access Hospital owned by the local government, patients with high-deductible plans may find paying cash directly more cost-effective than using insurance, as the negotiated rates paid by insurers like Blue Cross Blue Shield and UnitedHealthcare range from $50 to $70, often exceeding the cash price. It is important to note that while the facility's negotiated rates are higher than the cash option, the Medicare benchmark for this code is $32.73, indicating that the cash rate is still significantly above the federal baseline but represents a substantial discount from the full chargemaster list.
Patients should be aware that commercial insurance contracts often result in higher final costs due to administrative overhead and network tiering, even when the facility is in-network. To minimize out-of-pocket expenses, individuals should explicitly ask the hospital about "self-pay" or "prompt-pay" discounts before scheduling, as paying in full upfront can sometimes bypass the standard insurance billing cycle and reduce the total amount owed. Furthermore, if a patient receives a bill that includes unexpected charges from out-of-network providers, such as emergency services or specific lab tests, they should not immediately pay the full amount; instead, they should request an itemized audit to identify errors or double-billing, as over 80% of hospital bills contain mistakes that can be corrected through a formal written dispute.