Physical therapy (neuromuscular re-education)
Facility: Susan B Allen Memorial Hospital
Billing Code: 97112 (CPT)
- CPT Billing Code: 97112
- Insurance Median: $554
- Cash Discount Price: $140
- vs. Medicare Baseline: 16.93x 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 1693% of the Medicare baseline (a markup of 1593%). 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 |
|---|---|---|
| UnitedHealthcare | $350 | 1069% |
| Providrs Care | $757 | 2313% |
Consumer Guidance & Cost Commentary
For the CPT code 97112, representing neuromuscular re-education physical therapy, Susan B Allen Memorial Hospital in El Dorado, KS, lists a cash median price of $140.00. This cash rate is significantly lower than the facility's negotiated rates, which range from $350 to $757 depending on the insurance carrier. While the facility's negotiated rates are higher than the cash option, patients with high-deductible plans may find the cash price more advantageous if their insurance negotiated rate exceeds $140.00. It is important to note that the cash median is also lower than the state average for this service, making it a potentially cost-effective option for those paying out-of-pocket.
When evaluating the facility's pricing against federal standards, the Medicare amount for this procedure is $32.73. The facility's cash rate of $140.00 represents a markup of 16.9% above the Medicare benchmark, which aligns with fair pricing standards typically defined as 120% to 150% of the Medicare rate. Commercial negotiated rates often average 200% to 300% of Medicare, so the cash price here offers a more transparent and lower-cost alternative. To ensure you receive the best possible rate, we recommend asking the hospital directly about "self-pay" or "prompt-pay" discounts, which can further reduce the final bill by 20% to 50% if paid in full upfront.