Physical therapy (neuromuscular re-education)
Facility: Smith County Memorial Hospital
Billing Code: 97112 (CPT)
- CPT Billing Code: 97112
- Insurance Median: $79
- Cash Discount Price: $84
- vs. Medicare Baseline: 2.41x 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 241% of the Medicare baseline (a markup of 141%). 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 | $50 | 153% |
| Medicaid / KanCare | $59 - $84 | 180% |
| Multiplan-All Plans | $76 | 232% |
| Wppa-All Plans | $79 | 241% |
| UnitedHealthcare | $80 | 244% |
| Midlands Choice-All Plans | $80 | 244% |
| Health Partners Of Ks Ppo-All Plans | $80 | 244% |
Consumer Guidance & Cost Commentary
For the physical therapy service code 97112 at Smith County Memorial Hospital in Smith Center, Kansas, the facility's cash price is $84.00, which matches the median cash rate for this procedure in the region. While the facility is a Critical Access Hospital with government-local ownership, the negotiated rates paid by insurance carriers range from $50.00 to $84.00, with most plans settling at $79.00. This negotiated amount is notably higher than the Medicare benchmark of $32.73, reflecting the standard administrative markup inherent in commercial contracts. Patients with high-deductible plans should be aware that paying the cash price of $84.00 upfront might be more cost-effective than relying on insurance, as the negotiated rate often exceeds the cash price due to the administrative costs and contract structures that inflate the billed amount.
To minimize out-of-pocket expenses, patients should proactively contact the hospital to inquire about "self-pay" or "prompt-pay" discounts, which can reduce the final bill by 20% to 50% if paid in full before or shortly after the service. It is also important to verify your specific plan's deductible status before scheduling, as using insurance without meeting your deductible could result in paying the full negotiated rate rather than a share of the cost. Finally, if you receive a bill, always request a detailed itemized statement rather than accepting a summary invoice, as over 80% of hospital bills contain errors such as unbundled codes or charges for services not rendered. By comparing the facility's rates directly to the Medicare benchmark and seeking written confirmation of any discounts, you can ensure you are receiving fair pricing for your