CMS Price Transparency Data

Physical therapy (neuromuscular re-education)

Facility: Elizabethtown Community Hospital

Billing Code: 97112 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97112
Insurance Median: $81
Cash Discount Price: $142
vs. Medicare Baseline: 2.47x Medicare

The contracted insurance negotiated median rate for a Physical therapy (neuromuscular re-education) at Elizabethtown Community Hospital is $81. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $142. Compared to the federal Medicare reimbursement reference rate of $32.73, this hospital’s rate is 2.47x the Medicare baseline. Located in 75 Park Street, Elizabethtown, NY.

Cash / Self-Pay

$142

Average discount available for prompt cash payment at this facility.

Insurance Median

$81

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: $142 (434%)

Insurance Median: $81 (247%)

Cash: $142 (434% of Medicare)

Ins. Median: $81 (247% 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 247% of the Medicare baseline (a markup of 147%). 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
Capital District Physicians' Health Plan	$36 - $117	110%
Mvp	$41 - $111	125%
UnitedHealthcare	$41 - $131	125%
Blue Cross Blue Shield	$43 - $107	131%
Fidelis Care	$43 - $92	131%
Aetna	$54 - $106	165%
Choicecare	$54 - $114	165%
Martins Point	$54	165%
Veterans Affairs Community Care Network	$54	165%
Wellpath	$81	247%
Emblem Health	$114	348%
Harvard Pilgrim	$114	348%
Magnacare	$114	348%
Highmark Blueshield	$116	354%
Coventry	$121	370%
Multiplan	$128	391%

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 $142.
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 Elizabethtown Community 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.