CMS Price Transparency Data

Physical therapy (manual therapy)

Facility: Kings County Hospital Center

Billing Code: 97140 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97140
Insurance Median: $119
Cash Discount Price: $34
vs. Medicare Baseline: 4.29x Medicare

The contracted insurance negotiated median rate for a Physical therapy (manual therapy) at Kings County Hospital Center is $119. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $34. Compared to the federal Medicare reimbursement reference rate of $27.72, this hospital’s rate is 4.29x the Medicare baseline. Located in 451 Clarkson Avenue, Brooklyn, NY.

Cash / Self-Pay

$34

Average discount available for prompt cash payment at this facility.

Insurance Median

$119

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%)

Cash / Self-Pay: $34 (123%)

Insurance Median: $119 (429%)

Cash: $34 (123% of Medicare)

Ins. Median: $119 (429% 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 429% of the Medicare baseline (a markup of 329%). 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	$15 - $267	54%
Aetna	$18 - $257	65%
Affinity	$27 - $267	97%
Local 1199	$30 - $254	108%
Blue Cross Blue Shield	$31 - $267	112%
Centerlight	$31 - $149	112%
Elderplan	$31 - $194	112%
Fidelis	$31 - $267	112%
Wellcare	$31 - $33	112%
Centers Plan For Healthy Living	$32	115%
Hamaspik	$33	119%
Oscar	$39 - $614	141%
Carelon	$53 - $194	191%
Emblem	$57 - $319	206%
Multiplan	$65 - $239	234%
Villagecare Max	$69 - $254	249%
Vnsny	$69 - $254	249%
Metroplus	$111 - $267	400%
Amidacare	$119	429%
Senior Whole Health	$119	429%
United	$119 - $504	429%
United Behavioral Health	$119 - $131	429%
Carelon (Amida Care)	$121	437%
Magnacare	$224 - $320	808%
Oxford	$236 - $410	851%
Cigna	$241	869%

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 $34.
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 Kings County 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.