Physical therapy (neuromuscular re-education)
Facility: Mitchell County Hospital Health Systems
Billing Code: 97112 (CPT)
- CPT Billing Code: 97112
- Insurance Median: $85
- Cash Discount Price: $80
- vs. Medicare Baseline: 2.60x 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 260% of the Medicare baseline (a markup of 160%). 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 | $31 - $89 | 95% |
| Blue Cross Blue Shield | $50 | 153% |
| Triwest Well Mark All Plans | $76 | 232% |
| Aetna | $80 | 244% |
| First Health-All Plans | $80 | 244% |
| Pref Hlth Care Sytms Comm - All Plans | $80 | 244% |
| Phc Leased Ntwrk Access - All Plans | $85 | 260% |
| Auxiant-All Plans | $85 | 260% |
| Multiplan Ppo - All Plans | $85 | 260% |
| Health Partners Ks-All Plans | $88 | 269% |
| Cigna | $88 | 269% |
Consumer Guidance & Cost Commentary
For the CPT code 97112, representing physical therapy neuromuscular re-education, Mitchell County Hospital Health Systems lists a gross charge of $89.00. While the facility's cash median is $80.00 and the median negotiated rate across its 11 payers is $85.00, these figures are significantly higher than the Medicare benchmark of $32.73. Under Medicare benchmarking principles, commercial rates often average 200% to 300% of the Medicare rate, whereas fair pricing is typically defined as 120% to 150%. In this case, the negotiated rates exceed the fair pricing threshold, suggesting that for patients with high-deductible plans, paying the cash price of $80.00 upfront could result in lower out-of-pocket costs compared to insurance claims that may be subject to administrative markups.
Patients should verify their specific plan details before scheduling, as negotiated rates vary widely among payers, ranging from $31.00 for UnitedHealthcare to $89.00 for UnitedHealthcare's highest tier. It is important to check with the hospital directly for "self-pay" or "prompt-pay" discounts, which can reduce bills by 20% to 50% by bypassing costly claims processing and administrative overhead. Additionally, while the No Surprises Act protects against balance billing for emergency care and non-emergency services at in-network facilities, patients should request an itemized billing audit to ensure no unbundled codes or services not rendered are included in the final invoice.