CMS Price Transparency Data
Physical therapy (neuromuscular re-education)
Facility: Watsonville Community Hospital
Billing Code: 97112 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 97112
- Insurance Median: $164
- Cash Discount Price: $164
- vs. Medicare Baseline: 5.01x Medicare
The contracted insurance negotiated median rate for a Physical therapy (neuromuscular re-education) at Watsonville Community Hospital is $164. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $164. Compared to the federal Medicare reimbursement reference rate of $32.73, this hospital’s rate is 5.01x the Medicare baseline. Located in 75 Nielson Street, Watsonville, CA.
Cash / Self-Pay
$164
Average discount available for prompt cash payment at this facility.
Insurance Median
$164
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: $164 (501%)
Insurance Median: $164 (501%)
Cash: $164 (501% of Medicare)
Ins. Median: $164 (501% 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 501% of the Medicare baseline (a markup of 401%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
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Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| California Childrens Srvs | $16 - $18 | 49% |
| Healthy Families | $16 - $18 | 49% |
| Medi-Cal/Eds | $16 - $18 | 49% |
| Ccs/Monterey County | $16 - $18 | 49% |
| Medi-Cal E.R. | $16 - $18 | 49% |
| Well Path | $16 - $273 | 49% |
| Medicaid / KanCare | $16 - $18 | 49% |
| Alliance/Sccho | $18 - $30 | 55% |
| Alignment Health Plan | $36 | 110% |
| Secure Horizons Dign HMO | $36 - $55 | 110% |
| UnitedHealthcare | $36 - $164 | 110% |
| Secure Horizons | $36 | 110% |
| Health Net of California | $36 - $171 | 110% |
| Medicare (plans) | $36 - $37 | 110% |
| Blue Shield PPO | $37 | 113% |
| Hartford Workers' Comp | $37 | 113% |
| Tricare | $37 | 113% |
| Miscellaneous Work Comp | $37 | 113% |
| Workers Comp | $37 | 113% |
| Crawford & Co | $37 | 113% |
| Veterans Administration | $37 | 113% |
| U.S. Dept. of Labor | $37 | 113% |
| Kemper Group Workers Comp | $37 | 113% |
| Pinnacle Healthcare Uc | $37 | 113% |
| Ace-Usa | $37 | 113% |
| Republic Idemnity W/Comp | $37 | 113% |
| Liberty Mutual Work Comp | $37 | 113% |
| Fireman's Fund Work Comp | $37 | 113% |
| Keenan & Assoc Work Comp | $37 | 113% |
| Western Growers Work Comp | $37 | 113% |
| Gallagher Bassett Svcs | $37 | 113% |
| Beta Healthcare Group | $37 | 113% |
| Fleming & Associates | $37 | 113% |
| Travelers Insurance | $37 - $273 | 113% |
| Medicruz | $49 | 150% |
| Victim Compensation Plan | $49 - $273 | 150% |
| Blue Shield HMO | $55 | 168% |
| Aetna | $55 - $224 | 168% |
| Cigna | $55 - $191 | 168% |
| Great-West/Phcs | $55 - $191 | 168% |
| Pacificare HMO | $55 - $164 | 168% |
| Blue Cross Blue Shield | $55 - $243 | 168% |
| Health Net Pmg HMO | $55 - $171 | 168% |
| Western Growers Trust/Bc | $109 - $243 | 333% |
| Pinnacle Claims Tpa/Bc | $109 - $243 | 333% |
| Kaiser Northern | $120 | 367% |
| Western Health Advantage | $137 | 419% |
| Self Pay | $164 | 501% |
| Pacificare PPO | $164 | 501% |
| Health Net Smartcare Netw | $164 | 501% |
| Health Net Canopycare HMO | $171 | 522% |
| Health Net Blue and Gold | $171 | 522% |
| First Health | $191 - $219 | 584% |
| Geha (Ccn) | $191 - $219 | 584% |
| Adventist Risk Management | $191 - $219 | 584% |
| Transwestern | $191 - $219 | 584% |
| Private Healthcare System | $213 | 651% |
| Multiplan Inc PPO | $213 | 651% |
| Coastal Healthcare Admin | $232 - $246 | 709% |
| Salinas Valley Mem Hops | $232 | 709% |
| Claims Management Wc | $237 - $243 | 724% |
| City of Wats/Pinnacle Clm | $237 - $243 | 724% |
| Robert Kennedy/Ccn | $237 - $243 | 724% |
| Laborers Health & Welfare | $237 - $243 | 724% |
| Operating Engineers | $237 - $243 | 724% |
| Carpenters H&W Trust | $237 - $243 | 724% |
| Delta Health Systems | $237 - $243 | 724% |
| Calif Ironworkers Field | $237 - $243 | 724% |
| Teamsters Benefit Trust | $237 - $243 | 724% |
| State Compensation Fund | $237 - $243 | 724% |
| Sheet Metal Workers | $237 - $243 | 724% |
| Monterey Bay Pub Emp Trst | $237 - $243 | 724% |
| Aarp | $273 | 834% |
| Prucare Pmg HMO | $273 | 834% |
| Physicians Mutual | $273 | 834% |
| Bankers Life & Casualty | $273 | 834% |
| Apwu Health Plan | $273 | 834% |
| State Farm Ins | $273 | 834% |
| Humana | $273 | 834% |
| Sutter Health Plus | $273 | 834% |
| Wholesale Beer Distributo | $273 | 834% |
| North Calif Bakery Driver | $273 | 834% |
| Miscellaneous Auto | $273 | 834% |
| United Administrative | $273 | 834% |
| Prucare Pmg POS | $273 | 834% |
| Miscellaneous Insurance | $273 | 834% |
| Aaa | $273 | 834% |
| Farmers Insurance | $273 | 834% |
| Allstate | $273 | 834% |
| Zenith National Ins | $273 | 834% |