CMS Price Transparency Data

Physical therapy (neuromuscular re-education)

Facility: Margaretville Memorial Hospital

Billing Code: 97112 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97112
Insurance Median: $159
Cash Discount Price: $221
vs. Medicare Baseline: 4.86x Medicare

The contracted insurance negotiated median rate for a Physical therapy (neuromuscular re-education) at Margaretville Memorial Hospital is $159. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $221. Compared to the federal Medicare reimbursement reference rate of $32.73, this hospital’s rate is 4.86x the Medicare baseline. Located in 42084 State Highway 28, Margaretville, NY.

Cash / Self-Pay

$221

Average discount available for prompt cash payment at this facility.

Insurance Median

$159

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: $221 (675%)

Insurance Median: $159 (486%)

Cash: $221 (675% of Medicare)

Ins. Median: $159 (486% 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 486% of the Medicare baseline (a markup of 386%). 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
UnitedHealthcare	$97 - $176	296%
Medicare (plans)	$97 - $146	296%
Hamaspik (McR)	$97	296%
Blue Cross Blue Shield	$97 - $201	296%
Aetna	$97 - $210	296%
Mvp Gold (McR)	$97	296%
Affinity By Molina McR	$102	312%
Cdphp	$107	327%
Mvp	$140	428%
Oxford	$147 - $165	449%
Emblem Select Care (Exchange)	$154	471%
Magnacare Standard	$155	474%
Emblem Ghi/Hip Ppo/Cbp	$156	477%
Oxford Exchange	$158	483%
Todays Options	$160	489%
Self-Pay	$169	516%
Multiplan	$181	553%
Emblem Ghi/Hip Hmo/Epo/Pos	$181	553%
First Health	$199	608%
Emblem	$230 - $270	703%
Mvp Exchange	$238	727%
Mvp Hmo/Ppo	$280	855%
Magnacare	$390	1192%
Magnacare Preferred	$413	1262%

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 $221.
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 Margaretville 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.