CMS Price Transparency Data

Physical therapy (neuromuscular re-education)

Facility: Fostoria Community Hospital

Billing Code: 97112 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97112
Insurance Median: $126
Cash Discount Price: $155
vs. Medicare Baseline: 3.85x Medicare

The contracted insurance negotiated median rate for a Physical therapy (neuromuscular re-education) at Fostoria Community Hospital is $126. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $155. Compared to the federal Medicare reimbursement reference rate of $32.73, this hospital’s rate is 3.85x the Medicare baseline. Located in 501 Van Buren Street, Fostoria, OH.

Cash / Self-Pay

$155

Average discount available for prompt cash payment at this facility.

Insurance Median

$126

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: $155 (474%)

Insurance Median: $126 (385%)

Cash: $155 (474% of Medicare)

Ins. Median: $126 (385% 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 385% of the Medicare baseline (a markup of 285%). 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
Buckeye Community Health Plan	$17 - $126	52%
Meridian Health Plan Of Mi	$17	52%
Dayton Area Health Plan Dba Caresource	$18 - $124	55%
UnitedHealthcare	$18 - $142	55%
Paramount Health Care	$30 - $126	92%
Blue Cross Blue Shield	$31 - $154	95%
Health Alliance Plan	$31 - $178	95%
Health Value Management	$31 - $52	95%
Buckeye Community Health Plan Inc	$35 - $86	107%
Aetna	$36 - $159	110%
Veterans Affairs	$52	159%
Amerihealth	$131	400%
Medical Mutual Of Ohio	$134 - $143	409%
Frontpath Health Coalition	$137	419%
Ohio Health Choice	$155	474%
Ohio Ppo Connect	$155 - $178	474%
Health Ohio Network	$188	574%
Connecticut General Life Insurance Company	$190	581%

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 $155.
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 Fostoria Community Hospital 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.