CMS Price Transparency Data

Physical therapy (neuromuscular re-education)

Facility: UW Health

Billing Code: 97112 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97112
Insurance Median: $73
Cash Discount Price: $33
vs. Medicare Baseline: 2.23x Medicare

The contracted insurance negotiated median rate for a Physical therapy (neuromuscular re-education) at UW Health is $73. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $33. Compared to the federal Medicare reimbursement reference rate of $32.73, this hospital’s rate is 2.23x the Medicare baseline. Located in 1401 East State Street, Rockford, IL.

Cash / Self-Pay

$33

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: $33 (101%)

Insurance Median: $73 (223%)

Cash: $33 (101% 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
Aetna	$22 - $125	67%
Blue Cross Blue Shield	$22 - $105	67%
Medicaid / KanCare	$22	67%
Humana	$32	98%
Medicare (plans)	$32 - $176	98%
Mychoice Wi Medical Adv	$32	98%
UnitedHealthcare	$32 - $135	98%
Quartz Aso	$42 - $69	128%
Quartz Fully Insured	$42 - $61	128%
Wps	$52	159%
Workers Comp	$55	168%
Beloit Healt System	$61 - $157	186%
Ecoh	$67 - $137	205%
Hfn	$67 - $137	205%
Alliance Premier Network	$70 - $95	214%
Mercy Care	$73	223%
The Alliance	$76 - $122	232%
Wps Ppo	$103 - $134	315%
Cigna	$106 - $139	324%
Mercycare	$124 - $162	379%
First Health/Coventry	$131 - $171	400%
Health Payment Systems	$155 - $202	474%
Healthsmart	$155 - $202	474%
Sheboygan Employers Health Network	$166 - $216	507%
Multiplan	$185 - $241	565%

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 $33.
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 UW Health 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.