Physical therapy (neuromuscular re-education)
Facility: Fredonia Regional Hospital
Billing Code: 97112 (CPT)
- CPT Billing Code: 97112
- Insurance Median: $70
- Cash Discount Price: $78
- vs. Medicare Baseline: 2.14x 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 214% of the Medicare baseline (a markup of 114%). 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 | $39 - $50 | 119% |
| Aetna | $40 - $70 | 122% |
| UnitedHealthcare | $40 - $229 | 122% |
| Veterans Programs - All Plans | $40 | 122% |
| Reserve National-All Plans | $70 | 214% |
| Cigna | $70 | 214% |
| Meritain-All Plans | $70 | 214% |
Consumer Guidance & Cost Commentary
For the CPT code 97112, representing neuromuscular re-education physical therapy at Fredonia Regional Hospital in Kansas, the cash price is $78.00, which matches the facility's median negotiated rate. While the hospital's cash price aligns with its internal negotiated average, it is important to note that commercial insurance rates vary significantly; for instance, UnitedHealthcare plans can range from $40 to $229, whereas Veterans Programs and Reserve National have fixed rates of $70.00. Patients with high-deductible plans may find the cash price of $78.00 more affordable than the negotiated rates their insurance carriers charge, as the cash amount is often lower than the commercial benchmarks. Additionally, because the facility is a Critical Access Hospital owned by the local government, patients should proactively ask about self-pay or prompt-pay discounts, which can further reduce the final bill by bypassing administrative processing fees.
When evaluating the cost of this service, it is crucial to compare the facility's rates against the Medicare benchmark rather than the hospital's gross chargemaster. The Medicare amount for this procedure is $32.73, which serves as the objective baseline for fair pricing. Commercial negotiated rates typically average between 200% and 300% of the Medicare rate, while fair pricing is generally defined as 120% to 150% of this benchmark. In this case, the facility's cash price of $78.00 represents a markup of 2.1 times the Medicare rate. To ensure you are not overpaying, patients should request a detailed, itemized billing audit to verify that all charges