Physical therapy (neuromuscular re-education)
Facility: Trego County Lemke Memorial Hospital
Billing Code: 97112 (CPT)
- CPT Billing Code: 97112
- Insurance Median: $69
- Cash Discount Price: $79
- vs. Medicare Baseline: 2.11x 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 211% of the Medicare baseline (a markup of 111%). 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 |
|---|---|---|
| Humana | $44 - $47 | 134% |
| Tricare | $48 - $50 | 147% |
| UnitedHealthcare | $56 - $95 | 171% |
| Va Ccn - All Plans | $56 - $59 | 171% |
| Aetna | $56 - $86 | 171% |
| Medicaid / KanCare | $56 - $95 | 171% |
| Ambetter / Centene | $61 - $65 | 186% |
| Blue Cross Blue Shield | $69 | 211% |
| Health Partners - All Plans | $86 - $90 | 263% |
| Healthy Blue Mcaid - All Plans | $90 - $95 | 275% |
Consumer Guidance & Cost Commentary
For the CPT code 97112, Physical therapy (neuromuscular re-education), Trego County Lemke Memorial Hospital in Wakeeney, KS, has a gross charge of $93.00. The facility's cash median rate is $79.00, which is lower than the negotiated rates paid by most major payers, including UnitedHealthcare ($56–$95), Aetna ($56–$86), and Medicaid/KanCare ($56–$95). While the facility's negotiated median is $69.00, patients with high-deductible plans or those without insurance may find the cash price of $79.00 more affordable than their insurance allowed amount, which could exceed the cash rate depending on their specific plan. It is important to note that while the facility is a Critical Access Hospital with government-local ownership, commercial insurance contracts often result in higher net prices due to administrative overhead and contract dynamics.
When comparing pricing benchmarks, the facility's cash rate of $79.00 is higher than the state of Kansas average for this service, which is $59.00. However, the Medicare benchmark for this procedure is $32.73, indicating that the cash price represents a significant markup over the federal government's cost-based rate. Patients should be aware that balance billing is generally prohibited for emergency care and non-emergency services at in-network facilities under the No Surprises Act, but unexpected charges can still occur if ancillary services are out-of-network. To minimize costs, patients should request a prompt-pay discount before scheduling, which can reduce the bill by 20% to 5