CMS Price Transparency Data

Physical therapy (manual therapy)

Facility: Montefiore Mount Vernon Hospital

Billing Code: 97140 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97140
Insurance Median: $77
Cash Discount Price: $158
vs. Medicare Baseline: 2.78x Medicare

The contracted insurance negotiated median rate for a Physical therapy (manual therapy) at Montefiore Mount Vernon Hospital is $77. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $158. Compared to the federal Medicare reimbursement reference rate of $27.72, this hospital’s rate is 2.78x the Medicare baseline. Located in 12 North 7Th Avenue, Mount Vernon, NY.

Cash / Self-Pay

$158

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

$27.72

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $27.72 (100%)

Cash / Self-Pay: $158 (570%)

Insurance Median: $77 (278%)

Cash: $158 (570% of Medicare)

Ins. Median: $77 (278% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $27.72 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 278% of the Medicare baseline (a markup of 178%). 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
American Postal Workers	$28	101%
UnitedHealthcare	$28 - $77	101%
Healthfirst	$30 - $125	108%
Metroplus	$30 - $138	108%
Blue Cross Blue Shield	$31 - $194	112%
Emblem	$31 - $284	112%
Fidelis	$31 - $134	112%
Point Comfort	$31	112%
Villagecaremax	$31	112%
Vnsny Choice	$31 - $88	112%
Wellcare	$32 - $78	115%
Humana	$34	123%
Longevity	$34	123%
Molina Healthcare Of Ny Affinity	$43 - $173	155%
Amidacare	$77	278%
Medicaid / KanCare	$77	278%
Mvp	$77 - $176	278%
Hamaspik	$81 - $83	292%
Vnsny Select Health	$88	317%
Elderplan	$194	700%
Cigna	$284 - $315	1025%
Aetna	$336 - $376	1212%
Centivo	$389	1403%
Northwell	$394	1421%

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 $158.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 97140.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Montefiore Mount Vernon Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 97140.
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.