Physical therapy (neuromuscular re-education)
Facility: Stormont Vail Hospital
Billing Code: 97112 (CPT)
- CPT Billing Code: 97112
- Insurance Median: $48
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 1.47x 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 |
|---|---|---|
| Blue Cross Blue Shield | $28 - $78 | 86% |
| UnitedHealthcare | $28 | 86% |
| Ambetter / Centene | $28 | 86% |
Consumer Guidance & Cost Commentary
For this physical therapy service at Stormont Vail Hospital in Topeka, KS, the negotiated payment rate of $48.00 is significantly lower than the facility's gross charge of $201.00, reflecting the standard administrative markup inherent in insurance billing. While the median amount paid by insurers in this region is $12,870.00, the cash median is not available for this specific code. It is important to note that cash-pay options can sometimes be more cost-effective for patients with high-deductible plans if the insurance negotiated rate exceeds the cash price, though in this instance, the data does not provide a cash median for direct comparison. Patients should verify with the hospital regarding "self-pay" or "prompt-pay" discounts, which can offer immediate fee reductions by bypassing the costly claims processing cycle.
The facility's pricing is benchmarked against Medicare, which sets a baseline of $32.73 for this procedure. The commercial negotiated rate of $48.00 represents a markup relative to this federal standard, illustrating how commercial rates often exceed the true cost of care delivery. Although the data does not include specific county or state average comparisons for this exact CPT code, the presence of multiple payer plans (Blue Cross Blue Shield, UnitedHealthcare, and Ambetter/Centene) indicates a competitive market environment. Consumers are advised to request an itemized billing audit before finalizing payment, as over 80% of hospital bills contain errors such as unbundled codes or services not rendered. By disputing any discrepancies in writing and refusing to sign away rights to surprise billing protections, patients can ensure they are only paying for the actual care received.