CMS Price Transparency Data

Physical therapy (neuromuscular re-education)

Facility: Montefiore New Rochelle Hospital

Billing Code: 97112 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97112
Insurance Median: $77
Cash Discount Price: $108
vs. Medicare Baseline: 2.35x Medicare

The contracted insurance negotiated median rate for a Physical therapy (neuromuscular re-education) at Montefiore New Rochelle Hospital is $77. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $108. Compared to the federal Medicare reimbursement reference rate of $32.73, this hospital’s rate is 2.35x the Medicare baseline. Located in 16 Guion Place, New Rochelle, NY.

Cash / Self-Pay

$108

Average discount available for prompt cash payment at this facility.

Insurance Median

$77

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: $108 (330%)

Insurance Median: $77 (235%)

Cash: $108 (330% of Medicare)

Ins. Median: $77 (235% 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 235% of the Medicare baseline (a markup of 135%). 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
Healthfirst	$35 - $36	107%
UnitedHealthcare	$35 - $77	107%
Emblem	$36 - $249	110%
Empire	$36 - $154	110%
Fidelis	$36 - $92	110%
Metroplus	$36 - $138	110%
Villagecaremax	$36	110%
Vnsny Choice	$36 - $88	110%
Wellcare	$37 - $78	113%
Amidacare	$38 - $77	116%
Partners_Health_Plan	$38	116%
Hamaspik	$39 - $81	119%
Humana	$39	119%
Molina Healthcare Of Ny Affinity	$49 - $170	150%
Medicaid / KanCare	$77	235%
Mvp	$77 - $176	235%
Vnsny Select Health	$88	269%
Oscar	$112	342%
Cigna	$278 - $294	849%
Aetna	$300 - $336	917%
Northwell	$364	1112%

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 $108.
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 Montefiore New Rochelle 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.