Physical therapy (neuromuscular re-education)
Facility: Ascension Via Christi Hospital Manhattan, Inc
Billing Code: 97112 (CPT)
- CPT Billing Code: 97112
- Insurance Median: $31
- Cash Discount Price: $42
- vs. Medicare Baseline: 0.95x 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 |
|---|---|---|
| Medicaid / KanCare | $27 - $28 | 82% |
| UnitedHealthcare | $27 - $85 | 82% |
| Aetna | $28 | 86% |
| Humana | $30 - $31 | 92% |
| Medicare (plans) | $30 - $31 | 92% |
| Va | $30 | 92% |
| Providrs Care | $42 | 128% |
| Smarthealth | $43 | 131% |
| Ambetter / Centene | $52 | 159% |
| Blue Cross Blue Shield | $55 - $58 | 168% |
Consumer Guidance & Cost Commentary
For the CPT code 97112, representing neuromuscular re-education physical therapy at Ascension Via Christi Hospital Manhattan, the facility's cash median price is $42.00. This cash rate is significantly lower than the negotiated rates charged to most insurance payers, which range from $27 to $58 depending on the plan. For example, Medicaid/KanCare plans pay a low of $27, while Blue Cross Blue Shield plans pay up to $58. Because commercial negotiated rates often include administrative overhead and contract premiums, paying cash directly can sometimes result in a lower out-of-pocket cost for patients with high-deductible plans, provided the insurance allowed amount exceeds the cash price. Patients should verify their specific plan's allowed amount before scheduling to determine if the cash rate offers the best financial value.
The facility's pricing is benchmarked against Medicare, which serves as a federal cost baseline for this service. The Medicare amount for this code is $32.73, and the facility's cash rate of $42.00 represents a markup of approximately 28% over the Medicare rate. While the data does not provide specific county or state average comparisons for this exact code, the facility's cash price remains competitive relative to the federal standard. To maximize savings, patients are encouraged to request a "prompt-pay" discount from the hospital before check-in, which can reduce the final bill by 20% to 50% for upfront payment. Additionally, patients should always request an itemized bill to review every charge, ensuring no errors or unbundled services are included, as over 80% of hospital bills contain discrepancies that can be corrected.