Physical therapy (neuromuscular re-education)
Facility: Amberwell Atchison Association
Billing Code: 97112 (CPT)
- CPT Billing Code: 97112
- Insurance Median: $99
- Cash Discount Price: $193
- vs. Medicare Baseline: 3.02x 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 302% of the Medicare baseline (a markup of 202%). 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 | $48 - $50 | 147% |
| Superior Select Mcr Adv - All Plans | $64 | 196% |
| Triwest - All Plans | $64 | 196% |
| Humana | $64 - $87 | 196% |
| UnitedHealthcare | $64 - $346 | 196% |
| Va Ccn - All Plans | $64 | 196% |
| Ambetter / Centene | $99 | 302% |
| Cigna | $106 | 324% |
| Aetna | $106 | 324% |
| Centrus Health Direct - All Plans | $145 | 443% |
| Oscar - All Plans | $145 | 443% |
| Multiplan - All Plans | $151 | 461% |
| Wppa Providrs Care - All Plans | $174 | 532% |
Consumer Guidance & Cost Commentary
For the CPT code 97112, representing physical therapy neuromuscular re-education, the facility's cash median rate is $193.00, which matches the gross charge listed. This cash price is notably higher than the state of Kansas average, where the median paid amount is $64.00. While commercial insurance negotiated rates range from $48 to $346 depending on the plan, patients with high-deductible plans may find paying the cash rate directly more economical if their insurance allowed amount exceeds $193.00. To secure the lowest possible cost, it is advisable to contact the facility directly to inquire about self-pay or prompt-pay discounts, which can significantly reduce the final bill.
When using insurance, patients should be aware that negotiated rates often include administrative overhead and may not reflect the true cost of care. The Medicare benchmark for this service is $32.73, providing a clear baseline to evaluate pricing markups; commercial rates are frequently 200% to 300% of this amount. If a patient receives care from an out-of-network provider or encounters unexpected ancillary services, they may face balance billing for the difference between the provider's chargemaster and the insurance allowed amount. To avoid surprise costs, consumers should request a full itemized billing audit before paying any invoice, ensuring that all charges are accurate and that no unbundled codes or services not rendered are included in the final statement.