CMS Price Transparency Data

Physical therapy (neuromuscular re-education)

Facility: Munson Healthcare Otsego Memorial Hospital

Billing Code: 97112 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97112
Insurance Median: $47
Cash Discount Price: $114
vs. Medicare Baseline: 1.44x Medicare

The contracted insurance negotiated median rate for a Physical therapy (neuromuscular re-education) at Munson Healthcare Otsego Memorial Hospital is $47. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $114. Compared to the federal Medicare reimbursement reference rate of $32.73, this hospital’s rate is 1.44x the Medicare baseline. Located in 825 N Center Ave, Gaylord, MI.

Cash / Self-Pay

$114

Average discount available for prompt cash payment at this facility.

Insurance Median

$47

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: $114 (348%)

Insurance Median: $47 (144%)

Cash: $114 (348% of Medicare)

Ins. Median: $47 (144% 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.

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	$16 - $84	49%
Mclaren Health Plan	$16 - $112	49%
Meridian	$16	49%
Molina	$16 - $34	49%
Priority Health	$16 - $93	49%
UnitedHealthcare	$16 - $107	49%
Blue Care Network	$31	95%
Hap (Health Alliance Plan)	$31 - $107	95%
Humana	$31	95%
Medicare (plans)	$31	95%
Michigan Amish Medical Board	$31	95%
Northern Michigan Mennonite Group	$31	95%
Aetna	$32 - $109	98%
Asr Physicians Care Network	$47 - $107	144%
Nomi Health	$50 - $107	153%
Employee Benefit Logistics	$53	162%
Hospice Of Michigan	$80	244%
Cigna	$85 - $93	260%
Munson Hospice	$94 - $852	287%
Enterprise Group Planning/Employee Benefit Plan	$107	327%
Cofinity	$114	348%
Provider Network Of America/Hawaii Mainland Administrative Group Health	$114	348%
Three Rivers Provider Network	$114	348%

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 $114.
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 Munson Healthcare Otsego 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.