CMS Price Transparency Data

Physical therapy (functional capacity test)

Facility: Spanish Peaks Regional Health Center

Billing Code: 97750 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97750
Insurance Median: $56
Cash Discount Price: $95
vs. Medicare Baseline: 1.66x Medicare

The contracted insurance negotiated median rate for a Physical therapy (functional capacity test) at Spanish Peaks Regional Health Center is $56. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $95. Compared to the federal Medicare reimbursement reference rate of $33.73, this hospital’s rate is 1.66x the Medicare baseline. Located in 23500 Us Highway 160, Walsenburg, CO.

Cash / Self-Pay

$95

Average discount available for prompt cash payment at this facility.

Insurance Median

$56

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: $95 (282%)

Insurance Median: $56 (166%)

Cash: $95 (282% of Medicare)

Ins. Median: $56 (166% 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.

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
Humana	$35 - $54	104%
Kaiser Ppo Mcr	$35 - $111	104%
Medicare (plans)	$35 - $54	104%
UnitedHealthcare	$35 - $103	104%
Devoted Health Mcr - All Plans	$37 - $57	110%
Apostrophe - All Plans	$46 - $100	136%
Blue Cross Blue Shield	$46 - $100	136%
Cofinity - All Plans	$46 - $102	136%
Connect For Health - All Plans	$46 - $103	136%
Friday Hp Chp - All Plans	$46 - $100	136%
Prov Ntwrk Of America - All Plans	$49 - $100	145%
Rmhp - All Plans	$53 - $103	157%
Beacon Health Op Only-All Plans	$56 - $99	166%
Kaiser Ppo - All Other Plans	$56 - $100	166%
Cigna	$89 - $100	264%
Multiplan Phcs - All Plans	$89 - $105	264%

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 $95.
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 Spanish Peaks Regional Health 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.