CMS Price Transparency Data

Physical therapy (manual therapy)

Facility: Elmhurst Hospital Center

Billing Code: 97140 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97140
Insurance Median: $110
Cash Discount Price: Unavailable
vs. Medicare Baseline: 3.97x Medicare

The contracted insurance negotiated median rate for a Physical therapy (manual therapy) at Elmhurst Hospital Center is $110. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $27.72, this hospital’s rate is 3.97x the Medicare baseline. Located in 79-01 Broadway, Elmhurst, NY.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$110

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%)

Insurance Median: $110 (397%)

Ins. Median: $110 (397% 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 397% of the Medicare baseline (a markup of 297%). 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
Aetna	$18 - $192	65%
Healthfirst	$25 - $225	90%
Wellcare	$33	119%
Fidelis	$44 - $225	159%
Blue Cross Blue Shield	$84 - $225	303%
Metroplus	$92 - $225	332%
Amidacare	$100	361%
Carelon	$100 - $194	361%
Senior Whole Health	$100	361%
United	$100 - $330	361%
United Behavioral Health	$100 - $110	361%
Affinity	$102 - $225	368%
Carelon (Amida Care)	$102	368%
Vnsny	$102 - $254	368%
Centerlight	$149	538%
Emblem	$150 - $228	541%
Elderplan	$194	700%
Villagecare Max	$209	754%
Magnacare	$224	808%
Oxford	$236 - $265	851%
Multiplan	$239	862%
Cigna	$241	869%
Oscar	$251	905%
Local 1199	$254	916%

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 $X.
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 Elmhurst Hospital Center 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.