Physical therapy (neuromuscular re-education)
Facility: Clay County Medical Center
Billing Code: 97112 (CPT)
- CPT Billing Code: 97112
- Insurance Median: $75
- Cash Discount Price: $79
- vs. Medicare Baseline: 2.29x 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 229% of the Medicare baseline (a markup of 129%). 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 | $73 | 223% |
| Aetna | $73 | 223% |
| Health Partners - All Plans | $75 | 229% |
| Multiplan- All Plans | $75 | 229% |
| UnitedHealthcare | $75 | 229% |
Consumer Guidance & Cost Commentary
For the CPT code 97112, representing physical therapy neuromuscular re-education, Clay County Medical Center in Clay Center, KS, lists a cash median price of $79.00. This cash rate is notably higher than the facility's median negotiated rate of $75.00 and exceeds the state average for this service. While commercial payers like Aetna, UnitedHealthcare, and Health Partners have negotiated rates ranging from $73.00 to $75.00, patients with high-deductible plans may find the cash price more advantageous if their insurance allowed amount is lower than $79.00. It is important to note that commercial rates often include administrative overhead for claims processing, which can inflate the baseline price compared to direct cash payments.
To maximize savings, patients should proactively request "self-pay" or "prompt-pay" discounts before scheduling, as these upfront fee reductions can bypass costly insurance billing cycles and administrative labor. Additionally, because the facility is a Critical Access Hospital with government local ownership, patients should verify their specific plan details to ensure they are not subject to balance billing, which occurs when a provider bills the difference between their full charge and the insurance allowed amount. Given that Medicare benchmarks this service at $32.73, the commercial rates reflect standard market pricing rather than a markup error, but consumers are encouraged to request an itemized bill to confirm all charges align with the negotiated or cash rates provided.