CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: Harlem Hospital Center

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $172
Cash Discount Price: Unavailable
vs. Medicare Baseline: 4.90x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at Harlem Hospital Center is $172. 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 $35.07, this hospital’s rate is 4.90x 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

$172

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$35.07

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $35.07 (100%)

Insurance Median: $172 (490%)

Ins. Median: $172 (490% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $35.07 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 490% of the Medicare baseline (a markup of 390%). 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	60%
Healthfirst	$31 - $258	88%
Wellcare	$42 - $161	120%
Fidelis	$56 - $258	160%
Metroplus	$107 - $258	305%
Amidacare	$115	328%
Blue Cross Blue Shield	$115 - $258	328%
Carelon	$115 - $174	328%
Senior Whole Health	$115	328%
United	$115 - $434	328%
United Behavioral Health	$115 - $126	328%
Affinity	$117 - $258	334%
Carelon (Amida Care)	$117	334%
Vnsny	$117 - $228	334%
Centerlight	$134	382%
Emblem	$172 - $319	490%
Elderplan	$174	496%
Magnacare	$201 - $320	573%
Villagecare Max	$209 - $228	596%
Multiplan	$214	610%
Local 1199	$228	650%
Oxford	$236 - $410	673%
Cigna	$241	687%
Oscar	$251 - $614	716%

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: 97530.

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 97530.
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.