CMS Price Transparency Data

Physical therapy (neuromuscular re-education)

Facility: Rockcastle County Hospital, Inc.

Billing Code: 97112 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97112
Insurance Median: $73
Cash Discount Price: $109
vs. Medicare Baseline: 2.23x Medicare

The contracted insurance negotiated median rate for a Physical therapy (neuromuscular re-education) at Rockcastle County Hospital, Inc. is $73. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $109. Compared to the federal Medicare reimbursement reference rate of $32.73, this hospital’s rate is 2.23x the Medicare baseline. Located in 145 Newcomb Avenue, Mount Vernon, KY.

Cash / Self-Pay

$109

Average discount available for prompt cash payment at this facility.

Insurance Median

$73

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$32.73

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $32.73 (100%)

Cash / Self-Pay: $109 (333%)

Insurance Median: $73 (223%)

Cash: $109 (333% of Medicare)

Ins. Median: $73 (223% of 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 223% of the Medicare baseline (a markup of 123%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Caresource Mcaid	$22	67%
Coventry Mcaid-All Plans	$22	67%
Medicaid / KanCare	$22	67%
Molina Mcaid	$22	67%
Passport Hp Hmo - All Plans	$22 - $40	67%
UnitedHealthcare	$22 - $63	67%
Tricare	$23	70%
Blue Cross Blue Shield	$31 - $112	95%
Caresource Mcr Adv-All Other Plans	$31	95%
Humana	$31	95%
Molina Marketplace - All Other Plans	$31	95%
Molina Mcr Adv	$31	95%
Signature Mcr Adv-All Plans	$31	95%
Wellcare Mcr Adv-All Other Plans	$31	95%
Multiplan-All Plans	$69 - $128	211%
Prime Health Services-All Plans	$69 - $128	211%
Integrated Hp-All Plans	$72 - $134	220%
Corvel - All Plans	$73 - $135	223%
Center Care-All Plans	$77 - $142	235%
Cigna	$79 - $146	241%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $109.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 97112.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Rockcastle County Hospital, Inc. is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 97112.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.