CMS Price Transparency Data

Physical therapy (gait training)

Facility: Harlem Hospital Center

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $167
Cash Discount Price: Unavailable
vs. Medicare Baseline: 5.75x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at Harlem Hospital Center is $167. 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 $29.06, this hospital’s rate is 5.75x 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

$167

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$29.06

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $29.06 (100%)

Insurance Median: $167 (575%)

Ins. Median: $167 (575% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $29.06 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 575% of the Medicare baseline (a markup of 475%). 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	$17 - $1,171	58%
Healthfirst	$26 - $250	89%
Wellcare	$35	120%
Fidelis	$46 - $135	158%
Metroplus	$57 - $265	196%
Amidacare	$60	206%
Blue Cross Blue Shield	$60 - $1,626	206%
Carelon	$60 - $758	206%
Senior Whole Health	$60	206%
United	$60 - $944	206%
United Behavioral Health	$60 - $66	206%
Affinity	$61 - $135	210%
Carelon (Amida Care)	$61	210%
Vnsny	$61 - $219	210%
Emblem	$90 - $977	310%
Centerlight	$123 - $129	423%
Elderplan	$160 - $167	551%
Magnacare	$185 - $320	637%
Multiplan	$197 - $206	678%
Villagecare Max	$209 - $219	719%
Local 1199	$219 - $796	754%
Oxford	$236 - $882	812%
Cigna	$241 - $1,500	829%
Oscar	$251 - $1,396	864%

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: 97116.

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 97116.
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.