CMS Price Transparency Data

Physical therapy (neuromuscular re-education)

Facility: Aurora Medical Ctr Oshkosh

Billing Code: 97112 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97112
Insurance Median: $274
Cash Discount Price: $88
vs. Medicare Baseline: 8.37x Medicare

The contracted insurance negotiated median rate for a Physical therapy (neuromuscular re-education) at Aurora Medical Ctr Oshkosh is $274. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $88. Compared to the federal Medicare reimbursement reference rate of $32.73, this hospital’s rate is 8.37x the Medicare baseline. Located in 855 N Westhaven Drive, Oshkosh, WI.

Cash / Self-Pay

$88

Average discount available for prompt cash payment at this facility.

Insurance Median

$274

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: $88 (269%)

Insurance Median: $274 (837%)

Cash: $88 (269% of Medicare)

Ins. Median: $274 (837% 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 837% of the Medicare baseline (a markup of 737%). 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
Health Eos Plus	$105	321%
Healthpartners	$131 - $350	400%
Health Eos	$140	428%
Aetna	$145 - $222	443%
UnitedHealthcare	$147 - $302	449%
Cigna	$148 - $320	452%
Blue Cross Blue Shield	$149 - $357	455%
Everpointe Elite	$259	791%
Aurora Caregiver	$260	794%
Molina Exchange	$266	813%
Quartz One	$270	825%
Centivo	$274	837%
Common Ground	$281	859%
Hs Technology	$304	929%
Quartz Group	$320	978%
Health Payment Systems	$325	993%
Trilogy	$328	1002%
Wisconsin Physician Service	$359 - $378	1097%

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 $88.
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 Aurora Medical Ctr Oshkosh 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.