CMS Price Transparency Data

Physical therapy (functional capacity test)

Facility: Hospital for Special Surgery

Billing Code: 97750 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97750
Insurance Median: $184
Cash Discount Price: $182
vs. Medicare Baseline: 5.46x Medicare

The contracted insurance negotiated median rate for a Physical therapy (functional capacity test) at Hospital for Special Surgery is $184. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $182. Compared to the federal Medicare reimbursement reference rate of $33.73, this hospital’s rate is 5.46x the Medicare baseline. Located in 535 East 70Th Street, New York, NY.

Cash / Self-Pay

$182

Average discount available for prompt cash payment at this facility.

Insurance Median

$184

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: $182 (540%)

Insurance Median: $184 (546%)

Cash: $182 (540% of Medicare)

Ins. Median: $184 (546% 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 546% of the Medicare baseline (a markup of 446%). 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
Blue Cross Blue Shield	$10 - $203	30%
Affinity By Molina Health Plan [1005]	$77 - $169	228%
Connecticare [1039]	$77	228%
Emblem Health [1043]	$77 - $187	228%
Medicare (plans)	$77	228%
UnitedHealthcare	$77 - $275	228%
Fidelis Essential [1323]	$142 - $221	421%
Oxford [1096]	$169 - $218	501%
Aetna	$184 - $204	546%
Christian Brothers [1034]	$184 - $204	546%
Meritain Health [1085]	$184 - $204	546%
Nippon Life [1092]	$184 - $204	546%
Webtpa [1356]	$184 - $204	546%
Apwu [1016]	$185	548%
Cigna	$185	548%
Nalc [1090]	$185	548%
Qualcare [1101]	$185	548%
Wellfleet [1361]	$185	548%
Student Resources [1103]	$187 - $241	554%
Harvard Pilgrim [1057]	$213 - $275	631%
Geha [1053]	$241	714%

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 $182.
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 Hospital for Special Surgery 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.