CMS Price Transparency Data

Physical therapy (neuromuscular re-education)

Facility: University of Wi Hospitals & Clinics Authority

Billing Code: 97112 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 97112
  • Insurance Median: $132
  • Cash Discount Price: $126
  • vs. Medicare Baseline: 4.03x Medicare
The contracted insurance negotiated median rate for a Physical therapy (neuromuscular re-education) at University of Wi Hospitals & Clinics Authority is $132. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $126. Compared to the federal Medicare reimbursement reference rate of $32.73, this hospital’s rate is 4.03x the Medicare baseline. Located in 600 Highland Avenue, Madison, WI.
Cash / Self-Pay
$126

Average discount available for prompt cash payment at this facility.

Insurance Median
$132

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: $126 (385%)
Insurance Median: $132 (403%)
Cash: $126 (385% of Medicare)
Ins. Median: $132 (403% 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 403% of the Medicare baseline (a markup of 303%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash 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
Medicare (plans) $63 - $147 192%
Blue Cross Blue Shield $86 - $350 263%
Alliance_Premier_Network $100 306%
Mercycare $104 318%
Triology $107 - $128 327%
Security_Health_Plan $113 - $133 345%
Employer'S_Coalition_On_Health $116 - $162 354%
Alliance $118 361%
Hfn $120 - $162 367%
United_Healthcare $120 - $178 367%
Beloit_Health_System $122 373%
Aspirus_Health_Plan $123 376%
Cigna $126 385%
Health_Partners_Insurance $128 391%
Health_Payment_Systems $129 394%
UnitedHealthcare $131 400%
Dean_Health_Plan $134 409%
Medical_Associates $139 425%
Wps $146 - $160 446%
Employers_Healthcare_Coalition_Of_Wi $147 449%
Aetna $150 - $168 458%
Aspirus_Network_Inc $162 495%
Chorus_Community $168 513%
Ghc_Eau_Claire_Health_Plan $168 513%
Multiplan $168 - $193 513%
Sheybogan_Employers_Health_Network $168 513%
Coventry $178 544%
Dean_Care $178 544%
Healthsmart $185 565%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 600 Highland Avenue, Madison, WI 53792
  • CMS Rating: ★★★★★
  • Ownership Type: Government - Hospital District or Authority
  • Hospital Type: Acute Care Hospitals