Physical therapy (neuromuscular re-education)
Facility: Wamego Health Center
Billing Code: 97112 (CPT)
- CPT Billing Code: 97112
- Insurance Median: $28
- Cash Discount Price: $75
- vs. Medicare Baseline: 0.86x 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 | 82% |
| Aetna | $28 | 86% |
| Providrs Care | $42 | 128% |
| Blue Cross Blue Shield | $66 - $70 | 202% |
Consumer Guidance & Cost Commentary
For the CPT code 97112, representing physical therapy neuromuscular re-education at Wamego Health Center, the facility's cash median rate is $75.00. This cash price is notably lower than the negotiated rates paid by major payers in the area; for instance, UnitedHealthcare and Aetna pay $27.00 and $28.00 respectively, while Blue Cross Blue Shield pays between $66.00 and $70.00. When comparing these figures to the Medicare benchmark of $32.73, the cash rate represents a 135% markup, whereas the negotiated rates for most insurers fall between 83% and 214% of the Medicare amount. Patients with high-deductible plans may find that paying the cash rate directly is more cost-effective than relying on insurance, as the negotiated allowed amounts often exceed the cash price, potentially leaving the patient responsible for the difference after their deductible is met.
The facility, a Critical Access Hospital in Wamego, KS, offers a median negotiated rate of $28.00 across its payer contracts, which is significantly lower than the gross charge of $187.00. To minimize out-of-pocket costs, patients should explicitly request "self-pay" or "prompt-pay" discounts before scheduling, as these upfront payment incentives can reduce the bill by 20% to 50%. It is important to note that balance billing is generally prohibited for emergency care and non-emergency services at in-network facilities under the No Surprises Act, though patients should verify their specific plan status to avoid unexpected charges. If a patient receives an