CMS Price Transparency Data

Physical therapy (neuromuscular re-education)

Facility: Elmhurst Hospital Center

Billing Code: 97112 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97112
Insurance Median: $208
Cash Discount Price: Unavailable
vs. Medicare Baseline: 6.36x Medicare

The contracted insurance negotiated median rate for a Physical therapy (neuromuscular re-education) at Elmhurst Hospital Center is $208. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $32.73, this hospital’s rate is 6.36x the Medicare baseline. Located in 79-01 Broadway, Elmhurst, NY.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$208

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%)

Insurance Median: $208 (636%)

Ins. Median: $208 (636% 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 636% of the Medicare baseline (a markup of 536%). 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
Aetna	$20 - $257	61%
Healthfirst	$29 - $225	89%
Wellcare	$39	119%
Fidelis	$52 - $225	159%
Metroplus	$92 - $225	281%
Amidacare	$100	306%
Blue Cross Blue Shield	$100 - $272	306%
Carelon	$100 - $221	306%
Senior Whole Health	$100	306%
United	$100 - $504	306%
United Behavioral Health	$100 - $110	306%
Affinity	$102 - $225	312%
Carelon (Amida Care)	$102	312%
Vnsny	$102 - $289	312%
Emblem	$150 - $319	458%
Centerlight	$170	519%
Villagecare Max	$209 - $289	639%
Elderplan	$221	675%
Oxford	$236 - $410	721%
Cigna	$241	736%
Oscar	$251 - $614	767%
Magnacare	$255 - $320	779%
Multiplan	$272	831%
Local 1199	$289	883%

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 $X.
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 Elmhurst Hospital Center 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.