Physical therapy (neuromuscular re-education)
Facility: Scott County Hospital
Billing Code: 97112 (CPT)
- CPT Billing Code: 97112
- Insurance Median: $119
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 3.64x 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 364% of the Medicare baseline (a markup of 264%). 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 |
|---|---|---|
| UnitedHealthcare | $27 - $125 | 82% |
| Blue Cross Blue Shield | $50 | 153% |
| Humana | $55 | 168% |
| Wppa | $79 - $1,200 | 241% |
| Aetna | $119 | 364% |
Consumer Guidance & Cost Commentary
For the CPT code 97112, representing neuromuscular re-education physical therapy at Scott County Hospital, the negotiated rates paid by major insurers range from $27 to $1,200, with a median negotiated amount of $119. This commercial rate is significantly higher than the Medicare benchmark of $32.73, reflecting the typical administrative markup inherent in insurance contracts. While the facility is a Critical Access Hospital in Scott City, KS, the data does not provide specific cash or state/county average figures for direct comparison; however, patients should be aware that cash-pay options are often more affordable than insurance negotiated rates. If you have a high-deductible plan where your deductible has not yet been met, paying the cash price or seeking a prompt-pay discount may result in lower out-of-pocket costs than your insurance allowing.
To minimize unexpected costs, it is crucial to verify your specific plan's allowed amount before scheduling, as in-network rates vary widely among payers. If you choose to pay out-of-pocket, ask the billing department about self-pay or prompt-pay discounts, which can reduce the total bill by 20% to 50% if settled upfront. Should you receive a bill after insurance processing, ensure you have an itemized statement that lists every CPT code and service rendered to identify any errors, unbundled charges, or services not received. If a balance bill arises from an out-of-network provider, you may have protections under the No Surprises Act, and you should dispute the amount in writing rather than paying immediately to avoid unnecessary debt.