CMS Price Transparency Data

Physical therapy (neuromuscular re-education)

Facility: Stoughton Hospital

Billing Code: 97112 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97112
Insurance Median: $111
Cash Discount Price: $106
vs. Medicare Baseline: 3.39x Medicare

The contracted insurance negotiated median rate for a Physical therapy (neuromuscular re-education) at Stoughton Hospital is $111. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $106. Compared to the federal Medicare reimbursement reference rate of $32.73, this hospital’s rate is 3.39x the Medicare baseline. Located in 900 Ridge St, Stoughton, WI.

Cash / Self-Pay

$106

Average discount available for prompt cash payment at this facility.

Insurance Median

$111

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: $106 (324%)

Insurance Median: $111 (339%)

Cash: $106 (324% of Medicare)

Ins. Median: $111 (339% 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 339% of the Medicare baseline (a markup of 239%). 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
Medicaid / KanCare	$42	128%
Tricare	$46	141%
Healthnet Mcr Adv - All Plans	$51	156%
Dean Health Insurance Med Adv	$54	165%
Humana	$54 - $173	165%
Quartz Mcr Adv	$54	165%
Security Health/First Health - All Plans	$54	165%
Aetna	$58 - $163	177%
Quartz Health Solutions - All Other Lans	$58	177%
UnitedHealthcare	$84 - $154	257%
Alliance - All Plans	$111	339%
Dean Health Insurance Epo	$119	364%
Dean Health Insurance Comm - All Other Plans	$144	440%
Geha - All Plans	$144	440%
Cigna	$154	471%
Wisconsin Ppo Ppa Direct - All Plans	$154	471%
Blue Cross Blue Shield	$167	510%
Wps - All Plans	$173	529%

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 $106.
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 Stoughton 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.