CMS Price Transparency Data

Physical therapy (manual therapy)

Facility: Harlem Hospital Center

Billing Code: 97140 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97140
Insurance Median: $121
Cash Discount Price: Unavailable
vs. Medicare Baseline: 4.37x Medicare

The contracted insurance negotiated median rate for a Physical therapy (manual therapy) at Harlem Hospital Center is $121. 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 4.37x 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

$121

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: $121 (437%)

Ins. Median: $121 (437% 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 437% of the Medicare baseline (a markup of 337%). 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
Healthfirst	$16 - $258	58%
Aetna	$18 - $257	65%
Wellcare	$33	119%
Centerlight	$41 - $149	148%
Fidelis	$44 - $258	159%
Carelon	$53 - $194	191%
Elderplan	$53 - $194	191%
Emblem	$57 - $319	206%
Blue Cross Blue Shield	$65 - $258	234%
Multiplan	$65 - $239	234%
Local 1199	$69 - $254	249%
Villagecare Max	$69 - $254	249%
Vnsny	$69 - $254	249%
Metroplus	$107 - $258	386%
Amidacare	$115	415%
Senior Whole Health	$115	415%
United	$115 - $434	415%
United Behavioral Health	$115 - $126	415%
Affinity	$117 - $258	422%
Carelon (Amida Care)	$117	422%
Magnacare	$224 - $320	808%
Oxford	$236 - $410	851%
Cigna	$241	869%
Oscar	$251 - $614	905%

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 Harlem 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.