CMS Price Transparency Data

Physical therapy (functional capacity test)

Facility: Kings County Hospital Center

Billing Code: 97750 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97750
Insurance Median: $69
Cash Discount Price: $43
vs. Medicare Baseline: 2.05x Medicare

The contracted insurance negotiated median rate for a Physical therapy (functional capacity test) at Kings County Hospital Center is $69. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $43. Compared to the federal Medicare reimbursement reference rate of $33.73, this hospital’s rate is 2.05x the Medicare baseline. Located in 451 Clarkson Avenue, Brooklyn, NY.

Cash / Self-Pay

$43

Average discount available for prompt cash payment at this facility.

Insurance Median

$69

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%)

Cash / Self-Pay: $43 (127%)

Insurance Median: $69 (205%)

Cash: $43 (127% of Medicare)

Ins. Median: $69 (205% 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 205% of the Medicare baseline (a markup of 105%). 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	$19 - $267	56%
Aetna	$20 - $33	59%
United	$23 - $148	68%
Local 1199	$33	98%
Affinity	$34 - $267	101%
Amidacare	$38	113%
Blue Cross Blue Shield	$38 - $267	113%
Centerlight	$38	113%
Elderplan	$38	113%
Emblem	$38 - $160	113%
Fidelis	$38 - $267	113%
Wellcare	$39 - $41	116%
Centers Plan For Healthy Living	$40	119%
Hamaspik	$40	119%
Metroplus	$47 - $119	139%
Oscar	$48 - $57	142%
Carelon	$119	353%
Senior Whole Health	$119	353%
United Behavioral Health	$119 - $131	353%
Carelon (Amida Care)	$121	359%
Vnsny	$121	359%

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 $43.
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 Kings County 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.