CMS Price Transparency Data

Physical therapy (neuromuscular re-education)

Facility: Fort Memorial Hospital

Billing Code: 97112 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97112
Insurance Median: $126
Cash Discount Price: $59
vs. Medicare Baseline: 3.85x Medicare

The contracted insurance negotiated median rate for a Physical therapy (neuromuscular re-education) at Fort Memorial Hospital is $126. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $59. Compared to the federal Medicare reimbursement reference rate of $32.73, this hospital’s rate is 3.85x the Medicare baseline. Located in 611 Sherman Ave E, Fort Atkinson, WI.

Cash / Self-Pay

$59

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: $59 (180%)

Insurance Median: $126 (385%)

Cash: $59 (180% 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
Blue Cross Blue Shield	$15 - $271	46%
Dean Health Plan	$15 - $120	46%
Medicaid / KanCare	$15	46%
Quartz	$15 - $184	46%
UnitedHealthcare	$15 - $140	46%
Managed Health Services	$16	49%
Humana	$33 - $131	101%
Molina	$34	104%
Veteran Evaluation Services	$53	162%
Aetna	$68 - $138	208%
Fort Care	$105	321%
Group Health Cooperative	$109 - $263	333%
Alliance	$121 - $132	370%
Mercycare	$125 - $137	382%
Trilogy	$148 - $162	452%
Cigna	$160 - $175	489%
Centivo	$288 - $300	880%

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 $59.
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 Fort Memorial 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.