Physical therapy (neuromuscular re-education)
Facility: Memorial Hospital
Billing Code: 97112 (CPT)
- CPT Billing Code: 97112
- Insurance Median: $76
- Cash Discount Price: $122
- vs. Medicare Baseline: 2.32x 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 232% of the Medicare baseline (a markup of 132%). 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 | $53 | 162% |
| Tricare | $53 - $69 | 162% |
| Humana | $53 - $69 | 162% |
| Medicare (plans) | $54 - $69 | 165% |
| Ambetter / Centene | $59 - $76 | 180% |
| Coventry - All Other Plans | $96 - $124 | 293% |
| Health Partners Of Kansas - All Plans | $101 - $130 | 309% |
| Preferred Healthcare-All Plans | $101 - $130 | 309% |
| Wppa/Providers Care-All Plans | $149 - $192 | 455% |
Consumer Guidance & Cost Commentary
For the CPT code 97112, representing neuromuscular re-education physical therapy at Memorial Hospital in Abilene, KS, the cash median rate is $122.00. This cash price is notably higher than the state average for this service, which is $72.00. While the facility's negotiated rates with major payers like Blue Cross Blue Shield and Tricare range from $53 to $69, these amounts often exceed the cash price. For patients with high-deductible plans, paying the cash rate of $122.00 upfront may be more cost-effective than relying on insurance, as the insurer's allowed amount could be higher than the cash price, potentially leaving the patient responsible for significant out-of-pocket costs after the deductible is met.
The facility, a Critical Access Hospital owned by a Government Hospital District, lists a Medicare benchmark of $32.73, which serves as the objective baseline for evaluating pricing markups. Commercial negotiated rates for this service generally range from $53 to $192 depending on the payer, with the highest rates seen from Wppa/Providers Care. To minimize unexpected costs, patients should explicitly request a "self-pay" or "prompt-pay" discount before scheduling, as these upfront payment incentives can reduce the bill by 20% to 50%. Additionally, if a patient receives a bill that includes charges for services not rendered or unbundled components, they should request a formal itemized audit to identify errors, as over 80% of hospital bills contain inaccuracies that can be corrected through written dispute.