CMS Price Transparency Data

Physical therapy (neuromuscular re-education)

Facility: Astria Toppenish Hospital

Billing Code: 97112 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97112
Insurance Median: $151
Cash Discount Price: $156
vs. Medicare Baseline: 4.61x Medicare

The contracted insurance negotiated median rate for a Physical therapy (neuromuscular re-education) at Astria Toppenish Hospital is $151. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $156. Compared to the federal Medicare reimbursement reference rate of $32.73, this hospital’s rate is 4.61x the Medicare baseline. Located in 502 W Fourth Ave, Toppenish, WA.

Cash / Self-Pay

$156

Average discount available for prompt cash payment at this facility.

Insurance Median

$151

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: $156 (477%)

Insurance Median: $151 (461%)

Cash: $156 (477% of Medicare)

Ins. Median: $151 (461% 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 461% of the Medicare baseline (a markup of 361%). 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
Ambetter / Centene	$20	61%
Medicaid / KanCare	$20 - $60	61%
Medicare (plans)	$20 - $200	61%
Molina	$20	61%
UnitedHealthcare	$20 - $200	61%
Va	$20	61%
Molina_Exchange	$26	79%
Aetna	$34 - $213	104%
Cigna	$34	104%
Humana	$34 - $242	104%
Li	$34	104%
Tricare	$34	104%
Zenith	$35	107%
Regence	$77 - $82	235%
Premera	$86 - $91	263%
Premera_Affordable_Care	$86 - $91	263%
Kaiser	$135	412%
Chpw_Cascade_Care	$144 - $152	440%
First_Choice	$157 - $167	480%
Tpsc	$178 - $189	544%
Bcchp	$228 - $242	697%
Great_Rivers	$228 - $242	697%
Healthcomp	$228 - $242	697%
Washington_State_Hca	$228 - $242	697%

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 $156.
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 Astria Toppenish 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.