CMS Price Transparency Data

Physical therapy (functional capacity test)

Facility: Harlem Hospital Center

Billing Code: 97750 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97750
Insurance Median: $129
Cash Discount Price: Unavailable
vs. Medicare Baseline: 3.82x Medicare

The contracted insurance negotiated median rate for a Physical therapy (functional capacity test) 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 $33.73, this hospital’s rate is 3.82x 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

$33.73

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $33.73 (100%)

Insurance Median: $129 (382%)

Ins. Median: $129 (382% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $33.73 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 382% of the Medicare baseline (a markup of 282%). 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	$20 - $192	59%
Healthfirst	$30 - $258	89%
Wellcare	$41	122%
Fidelis	$54 - $258	160%
Metroplus	$107 - $258	317%
Centerlight	$114	338%
Amidacare	$115	341%
Blue Cross Blue Shield	$115 - $258	341%
Carelon	$115 - $148	341%
Senior Whole Health	$115	341%
United	$115 - $284	341%
United Behavioral Health	$115 - $126	341%
Affinity	$117 - $258	347%
Carelon (Amida Care)	$117	347%
Vnsny	$117 - $193	347%
Emblem	$143 - $228	424%
Elderplan	$148	439%
Magnacare	$170	504%
Multiplan	$182	540%
Local 1199	$193	572%
Villagecare Max	$209	620%
Oxford	$236 - $265	700%
Cigna	$241	714%
Oscar	$251	744%

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: 97750.

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 97750.
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.