Physical therapy (neuromuscular re-education)
Facility: Bob Wilson Memorial Hospital
Billing Code: 97112 (CPT)
- CPT Billing Code: 97112
- Insurance Median: $171
- Cash Discount Price: $84
- vs. Medicare Baseline: 5.22x 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 522% of the Medicare baseline (a markup of 422%). 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 |
|---|---|---|
| Medicare (plans) | $67 | 205% |
| Aetna | $67 - $167 | 205% |
| Blue Cross Blue Shield | $67 | 205% |
| Humana | $67 | 205% |
| Kansas Health | $67 | 205% |
| UnitedHealthcare | $67 - $174 | 205% |
| Centura Employee Plan | $72 | 220% |
| Multiplan | $188 - $194 | 574% |
| Health Partners Of Kansas | $196 | 599% |
| Wppa | $198 | 605% |
Consumer Guidance & Cost Commentary
For the CPT code 97112, representing neuromuscular re-education physical therapy at Bob Wilson Memorial Hospital in Ulysses, KS, the facility's cash median price is $84.00. This cash rate is significantly lower than the negotiated rates paid by major payers, which range from $67 to $198 depending on the insurance plan. For example, while UnitedHealthcare plans pay up to $174 and Multiplan plans pay up to $194, patients paying out-of-pocket can expect to pay $84.00. Given that the facility is a Critical Access Hospital with a voluntary non-profit church ownership, the cash price may offer substantial savings for patients with high-deductible plans where the insurance negotiated rate exceeds the cash amount. It is advisable to explicitly request a self-pay classification and prompt-pay discount before scheduling services to ensure the lowest possible rate is applied, as billing systems often default to insurance processing once a card is on file.
The facility's Medicare benchmarking data shows a gross charge of $209.00, with a Medicare payment of $32.73. The cash price of $84.00 represents a 5.2% increase relative to the Medicare payment amount, which serves as the objective baseline for evaluating hospital pricing markups. While the data does not provide specific county or state average comparisons for this specific code, the significant difference between the cash rate and the highest negotiated rates (up to $198) highlights the potential for cost savings through direct payment. Patients should be aware that balance billing is generally prohibited for emergency care and non-emergency services at in-network facilities under the