CMS Price Transparency Data

Physical therapy (neuromuscular re-education)

Facility: Oak Valley Hospital District

Billing Code: 97112 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97112
Insurance Median: $111
Cash Discount Price: $119
vs. Medicare Baseline: 3.39x Medicare

The contracted insurance negotiated median rate for a Physical therapy (neuromuscular re-education) at Oak Valley Hospital District is $111. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $119. Compared to the federal Medicare reimbursement reference rate of $32.73, this hospital’s rate is 3.39x the Medicare baseline. Located in 350 S Oak Ave, Oakdale, CA.

Cash / Self-Pay

$119

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: $119 (364%)

Insurance Median: $111 (339%)

Cash: $119 (364% 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
Blue Cross Blue Shield	$18 - $199	55%
Healthnet Medi-Cal Ip/Op Only	$18	55%
Kaiser Medi-Cal Ip/Op Only	$18	55%
Medi-Cal Ip/Op Only	$18	55%
Hp Of San Joaquin Ip/Op Only-All Plans	$21	64%
Alignment Op Only Ip/Op Only-All Plans	$34	104%
Humana	$34	104%
Kaiser Mcr Adv Ip/Op Only	$34	104%
Scan Health Plan Ip/Op Only-All Plans	$35	107%
Imperial Health Ip/Op Only-All Plans	$38	116%
Healthnet Comm Op Only Ip/Op Only-All Other Plans	$73 - $130	223%
UnitedHealthcare	$74 - $133	226%
Kaiser Comm Ip/Op Only-All Other Plans	$77 - $137	235%
Cigna	$83 - $148	254%
Blue Shield Epn Ip/Op Only	$86 - $154	263%
Aetna	$106 - $188	324%
Blue Shield/Bcout Ip/Op Only-All Other Plans	$112 - $199	342%

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 $119.
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 Oak Valley Hospital District 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.