CMS Price Transparency Data

Physical therapy (functional capacity test)

Facility: Montefiore Mount Vernon Hospital

Billing Code: 97750 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97750
Insurance Median: $77
Cash Discount Price: Unavailable
vs. Medicare Baseline: 2.28x Medicare

The contracted insurance negotiated median rate for a Physical therapy (functional capacity test) at Montefiore Mount Vernon Hospital is $77. 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 2.28x the Medicare baseline. Located in 12 North 7Th Avenue, Mount Vernon, NY.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$77

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: $77 (228%)

Ins. Median: $77 (228% 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 228% of the Medicare baseline (a markup of 128%). 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
American Postal Workers	$35	104%
UnitedHealthcare	$35 - $77	104%
Healthfirst	$37 - $125	110%
Metroplus	$37 - $138	110%
Blue Cross Blue Shield	$38 - $173	113%
Emblem	$38 - $284	113%
Fidelis	$38 - $134	113%
Point Comfort	$38	113%
Villagecaremax	$38	113%
Vnsny Choice	$38 - $88	113%
Wellcare	$39 - $78	116%
Humana	$42	125%
Longevity	$42	125%
Molina Healthcare Of Ny Affinity	$53 - $173	157%
Amidacare	$77	228%
Medicaid / KanCare	$77	228%
Mvp	$77 - $176	228%
Hamaspik	$81 - $83	240%
Vnsny Select Health	$88	261%
Cigna	$284 - $315	842%
Northwell	$394	1168%

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 Montefiore Mount Vernon Hospital 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.