CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Harlem Hospital Center

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $129
Cash Discount Price: Unavailable
vs. Medicare Baseline: 3.98x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Harlem Hospital Center is $129. 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 $32.4, this hospital’s rate is 3.98x the Medicare baseline. Located in 506 Lenox Avenue, New York, NY.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$129

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$32.4

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $32.4 (100%)

Insurance Median: $129 (398%)

Ins. Median: $129 (398% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $32.4 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 398% of the Medicare baseline (a markup of 298%). 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	$21 - $257	65%
Healthfirst	$29 - $135	90%
Wellcare	$39	120%
Fidelis	$52 - $135	160%
Metroplus	$57 - $135	176%
Amidacare	$60	185%
Blue Cross Blue Shield	$60 - $181	185%
Carelon	$60 - $147	185%
Senior Whole Health	$60	185%
United	$60 - $434	185%
United Behavioral Health	$60 - $66	185%
Affinity	$61 - $135	188%
Carelon (Amida Care)	$61	188%
Vnsny	$61 - $193	188%
Emblem	$90 - $319	278%
Centerlight	$113	349%
Elderplan	$147	454%
Magnacare	$170 - $320	525%
Multiplan	$181	559%
Local 1199	$193	596%
Villagecare Max	$193 - $209	596%
Oxford	$236 - $410	728%
Cigna	$241	744%
Oscar	$251 - $614	775%

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: 97535.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Harlem Hospital Center is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 97535.
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.