CMS Price Transparency Data

Physical therapy (neuromuscular re-education)

Facility: Othello Community Hospital

Billing Code: 97112 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97112
Insurance Median: $112
Cash Discount Price: $105
vs. Medicare Baseline: 3.42x Medicare

The contracted insurance negotiated median rate for a Physical therapy (neuromuscular re-education) at Othello Community Hospital is $112. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $105. Compared to the federal Medicare reimbursement reference rate of $32.73, this hospital’s rate is 3.42x the Medicare baseline. Located in 315 North 14Th Avenue, Othello, WA.

Cash / Self-Pay

$105

Average discount available for prompt cash payment at this facility.

Insurance Median

$112

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: $105 (321%)

Insurance Median: $112 (342%)

Cash: $105 (321% of Medicare)

Ins. Median: $112 (342% 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 342% of the Medicare baseline (a markup of 242%). 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	$59 - $60	180%
Amerigroup Mcaid	$59	180%
Chp Mcaid	$59	180%
Cocare - All Plans	$59	180%
Gau - All Plans	$59	180%
Kaiser - All Plans	$59	180%
Molina Mcaid	$59	180%
UnitedHealthcare	$59 - $140	180%
Chp - All Other Plans	$60	183%
Molina - All Other Plans	$60	183%
Medicare (plans)	$70	214%
Tricare	$91	278%
Triwest - All Plans	$91	278%
Asuris - All Plans	$112	342%
Commercial Other - All Plans	$112	342%
Hma - All Plans	$112	342%
Hmso - All Plans	$112	342%
Tpsc - All Plans	$112	342%
Travelers - All Plans	$112	342%
Veterans Admin - All Plans	$112	342%
Blue Cross Blue Shield	$117	357%
Cigna	$124	379%
First Choice - All Plans	$126	385%
Aetna	$131	400%
Chp Mcr Adv	$140	428%
Health Alliance Mcr Adv - All Plans	$140	428%
Humana	$140	428%
Molina Mcare	$140	428%
Wellcare Mcr Adv - All Plans	$140	428%

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 $105.
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 Othello Community 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.