CMS Price Transparency Data

Physical therapy (neuromuscular re-education)

Facility: Montefiore Mount Vernon Hospital

Billing Code: 97112 (CPT)

The BaseRate · fair price medium confidence

A fair price for this

$71

about 2.2× the $33 Medicare rate · typically $32–$168

modeled estimate · not a bill or quote

What this hospital charges insurers

$77

About the fair price

about $6 over the fair price · 2.3× Medicare

Medicare pays $33 Fair price $71 This hospital $77 Cash price $146 Hospital's list price $225

How we calculate the fair BaseRate →

How this hospital compares to other NY hospitals

Highest price of the 9 NY hospitals we have prices for — worth calling around.

Cheapest $30 Priciest $77

Black dot = this hospital, among the 9 NY hospitals with a price for this procedure. Full list below.

A fair price for a Physical therapy (neuromuscular re-education) is about $71 (about 2.2× the $33 Medicare rate). Montefiore Mount Vernon Hospital charges insurers about $77, or about $146 in cash — about the fair price. Located in Mount Vernon, NY.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

5 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Cigna✓ Humana Kaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$35 - $77	107%
Blue Cross Blue Shieldmajor	$36 - $180	110%
Aetnamajor	$336 - $376	1027%
Cignamajor	$284 - $315	868%
Humanamajor	$40	122%
Fidelis Care	$36 - $134	110%
Molina	$50 - $173	153%
MVP Health Care	$77 - $176	235%
SelectHealth	$88	269%
WellCare	$37 - $78	113%
+ 13 smaller / regional plans	$35 - $394

Government programs also on file: Medicaid.

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price (about 146), before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the CPT code on your bill matches exactly: 97112.

Insurance Before you use insurance

Call your insurance company to confirm Montefiore Mount Vernon Hospital is in-network.
Ask your insurer whether prior approval is required for CPT code 97112.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

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Other Procedures at Montefiore Mount Vernon Hospital

Compare: Physical therapy (neuromuscular re-education) at other NY hospitals

Insurance negotiated median for the same procedure, sorted lowest first.