CMS Price Transparency Data

Physical therapy (neuromuscular re-education)

Facility: Ira Davenport Memorial Hospital

Billing Code: 97112 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97112
Insurance Median: $93
Cash Discount Price: $124
vs. Medicare Baseline: 2.84x Medicare

The contracted insurance negotiated median rate for a Physical therapy (neuromuscular re-education) at Ira Davenport Memorial Hospital is $93. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $124. Compared to the federal Medicare reimbursement reference rate of $32.73, this hospital’s rate is 2.84x the Medicare baseline. Located in 7571 State Route 54, Bath, NY.

Cash / Self-Pay

$124

Average discount available for prompt cash payment at this facility.

Insurance Median

$93

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: $124 (379%)

Insurance Median: $93 (284%)

Cash: $124 (379% of Medicare)

Ins. Median: $93 (284% 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 284% of the Medicare baseline (a markup of 184%). 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
Empire	$16	49%
Amerihealth Caritas Mcr Adv - All Plans	$31	95%
Blue Cross Blue Shield	$31 - $481	95%
Humana	$31 - $143	95%
Tricare	$31	95%
Fidelis	$44 - $55	134%
Fidelis Care - Exchange - All Plans	$68 - $87	208%
Geisinger - All Plans	$72 - $92	220%
Cigna	$77 - $99	235%
Mvp Health Plan - All Plans	$77 - $99	235%
Independent Health - All Plans	$81 - $103	247%
Upmc - All Plans	$86 - $109	263%
Pomco Inc - All Plans	$89 - $114	272%
Aetna	$93 - $119	284%
UnitedHealthcare	$93 - $130	284%
Emblem Health - All Plans	$109 - $139	333%
Emblem/Ghi	$115	351%
Martins Point - All Plans	$124 - $159	379%
Healthnow - All Plans	$409 - $522	1250%

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 $124.
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 Ira Davenport Memorial 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.