CMS Price Transparency Data

Physical therapy (functional capacity test)

Facility: Good Samaritan Hospital of Suffern

Billing Code: 97750 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 97750
  • Insurance Median: $203
  • Cash Discount Price: $399
  • vs. Medicare Baseline: 6.02x Medicare
The contracted insurance negotiated median rate for a Physical therapy (functional capacity test) at Good Samaritan Hospital of Suffern is $203. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $399. Compared to the federal Medicare reimbursement reference rate of $33.73, this hospital’s rate is 6.02x the Medicare baseline. Located in 255 Lafayette Avenue, Suffern, NY.
Cash / Self-Pay
$399

Average discount available for prompt cash payment at this facility.

Insurance Median
$203

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: $399 (1183%)
Insurance Median: $203 (602%)
Cash: $399 (1183% of Medicare)
Ins. Median: $203 (602% 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 602% of the Medicare baseline (a markup of 502%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash 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
Medicare (plans) $38 - $41 113%
Hamaspik (McR) $38 113%
Mvp Gold (McR) $38 113%
Tricare $38 113%
Affinity By Molina McR $40 119%
Beacon Exchange $46 136%
Beacon Commercial $50 148%
Self-Pay - Cc 30% $120 356%
Geisinger Health Commercial/Exchange $127 377%
Emblem Select Care (Exchange) $163 483%
Aetna $180 - $377 534%
Emblem Ghi/Hip PPO $192 569%
Emblem Ghi/Hip Hmo/Epo/Pos $192 569%
UnitedHealthcare $193 - $244 572%
Blue Cross Blue Shield $198 - $1,224 587%
Cdphp $200 593%
Self-Pay - Cc 50% $200 593%
Oxford $205 - $222 608%
Oxford Exchange $207 614%
Self-Pay $219 649%
Emblem $230 - $270 682%
Oxford Commercial $238 706%
Mvp $243 - $286 720%
Mvp Exchange $252 747%
Magnacare Standard $279 827%
Cigna $279 827%
Mvp Hmo/Ppo $297 881%
Multiplan $299 886%
PHCS $299 886%
First Health $339 1005%
Magnacare $390 1156%
Magnacare Preferred $413 1224%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 255 Lafayette Avenue, Suffern, NY 10901
  • CMS Rating: ★★★☆☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals