CMS Price Transparency Data

Physical therapy (functional capacity test)

Facility: Elmhurst Hospital Center

Billing Code: 97750 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97750
Insurance Median: $125
Cash Discount Price: Unavailable
vs. Medicare Baseline: 3.71x Medicare

The contracted insurance negotiated median rate for a Physical therapy (functional capacity test) at Elmhurst Hospital Center is $125. 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 3.71x the Medicare baseline. Located in 79-01 Broadway, Elmhurst, NY.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$125

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: $125 (371%)

Ins. Median: $125 (371% 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 371% of the Medicare baseline (a markup of 271%). 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 - $225	89%
Wellcare	$41	122%
Fidelis	$55 - $225	163%
Metroplus	$92 - $225	273%
Amidacare	$100	296%
Blue Cross Blue Shield	$100 - $225	296%
Carelon	$100 - $148	296%
Senior Whole Health	$100	296%
United	$100 - $330	296%
United Behavioral Health	$100 - $110	296%
Affinity	$102 - $225	302%
Carelon (Amida Care)	$102	302%
Vnsny	$102 - $193	302%
Centerlight	$114	338%
Emblem	$125 - $228	371%
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 Elmhurst 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.