Physical therapy (neuromuscular re-education)
Facility: William Newton Hospital
Billing Code: 97112 (CPT)
- CPT Billing Code: 97112
- Insurance Median: $50
- Cash Discount Price: $138
- vs. Medicare Baseline: 1.53x 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.
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 |
|---|---|---|
| Triwest- All Plans | $48 - $49 | 147% |
| Blue Cross Blue Shield | $48 - $50 | 147% |
| UnitedHealthcare | $49 - $125 | 150% |
| Ambetter / Centene | $49 - $139 | 150% |
| Providrs Care Nexus | $84 - $85 | 257% |
| Providrs Care - All Other Plans | $96 - $98 | 293% |
Consumer Guidance & Cost Commentary
For the CPT code 97112, representing physical therapy for neuromuscular re-education, William Newton Hospital in Winfield, KS, lists a cash price of $138.00. This cash rate is notably higher than the state of Kansas average, which is $50.00. While commercial insurance plans such as UnitedHealthcare and Ambetter / Centene have negotiated rates ranging from $49 to $139, patients with high-deductible plans should consider that paying the full cash price of $138.00 upfront might be more cost-effective than relying on insurance, which could result in a higher allowed amount after deductibles are met. It is important to verify your specific plan's deductible status and out-of-pocket maximums before deciding whether to use insurance or pay directly.
To ensure you are not overcharged, always request a full itemized bill before finalizing payment, as summary bills often obscure individual line items and potential errors. If you receive a balance bill for the difference between the facility's full charge and your insurance allowed amount, you may be protected under the No Surprises Act, which bans such billing for out-of-network services at in-network facilities. Additionally, ask the hospital directly about "self-pay" or "prompt-pay" discounts, which can reduce the total cost by 20% to 50% if you settle the account in full within a short window. Given that this facility is a Critical Access Hospital with government local ownership, confirming the specific billing classification and any available discounts prior to scheduling your visit is the most effective way to manage your healthcare costs.