CMS Price Transparency Data

Physical therapy (functional capacity test)

Facility: Craig Hospital

Billing Code: 97750 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97750
Insurance Median: $256
Cash Discount Price: $140
vs. Medicare Baseline: 7.59x Medicare

The contracted insurance negotiated median rate for a Physical therapy (functional capacity test) at Craig Hospital is $256. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $140. Compared to the federal Medicare reimbursement reference rate of $33.73, this hospital’s rate is 7.59x the Medicare baseline. Located in 3425 S Clarkson St, Englewood, CO.

Cash / Self-Pay

$140

Average discount available for prompt cash payment at this facility.

Insurance Median

$256

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: $140 (415%)

Insurance Median: $256 (759%)

Cash: $140 (415% of Medicare)

Ins. Median: $256 (759% 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 759% of the Medicare baseline (a markup of 659%). 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
Veterans Administration	$29	86%
Cms	$34	101%
UnitedHealthcare	$34 - $866	101%
Cigna	$161	477%
Kaiser	$191	566%
Blue Cross Blue Shield	$195	578%
Carisk Outcomes	$202	599%
Zenith	$219	649%
Aetna	$229	679%
Corvel Worker'S Comp	$236	700%
Liberty Mutual Worker'S Comp	$236	700%
Paradigm	$236	700%
Rocky Mountain Health Plan	$246	729%
Midwest Employers Casualty	$249	738%
Coventry/First Health	$253	750%
Fcci Worker'S Comp	$253	750%
Geha/Ppo Usa	$253	750%
Great-West Healthcare	$253	750%
Prime Health Services	$256	759%
First Choice Health	$263	780%
Multiplan/Phcs	$266	789%
Focus Worker'S Comp	$270	800%
General Reinsurance	$270 - $286	800%
Provider Network Of America	$270	800%
Three Rivers Provider Network	$270 - $276	800%
Wyoming Worker'S Comp	$270	800%
Allstate	$286	848%
Tricare	$286	848%
National Provider Network	$303	898%
Up & Up	$303	898%

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 $140.
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 Craig Hospital 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.