Physical therapy (neuromuscular re-education)
Facility: St Luke Hospital & Living Center
Billing Code: 97112 (CPT)
- CPT Billing Code: 97112
- Insurance Median: $36
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 1.10x 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.
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 | $36 | 110% |
| Bluestem Pace | $36 | 110% |
| Kansas Department Of Health And Environment | $36 | 110% |
| UnitedHealthcare | $36 | 110% |
| Va Ccn | $36 | 110% |
| Blue Cross Blue Shield | $36 | 110% |
| Ambetter / Centene | $37 | 113% |
Consumer Guidance & Cost Commentary
For Physical therapy (neuromuscular re-education) at St Luke Hospital & Living Center in Marion, KS, the facility's negotiated rates are consistently $36.00 across seven major payers, including Humana, UnitedHealthcare, and Blue Cross Blue Shield. This negotiated amount is significantly lower than the facility's gross charge of $71.00, reflecting the contractual caps that protect in-network members from balance billing. While the facility is a Critical Access Hospital owned by a Government Hospital District, patients should be aware that cash-pay options are not listed in this report. However, if you have a high-deductible plan, paying the full cash price directly might be cheaper than your insurance's negotiated rate if the allowed amount exceeds your out-of-pocket maximum, though current data does not show a specific cash median.
To ensure you are receiving the best possible price, it is crucial to verify your specific plan's deductible status before scheduling, as paying out-of-pocket may be more cost-effective if your insurance has not yet covered the service. Additionally, always request a "self-pay" or "prompt-pay" discount at registration; hospitals often offer 20% to 50% reductions for upfront payments to bypass administrative claim processing costs. If you receive a bill that appears higher than the negotiated rate of $36.00, do not accept a summary bill immediately. Instead, demand a full itemized CPT-coded statement to identify any errors, unbundled codes, or services not rendered, and dispute any discrepancies in writing to protect yourself from unexpected medical debt.