CMS Price Transparency Data

Physical therapy (functional capacity test)

Facility: Ascension St Vincent's Clay County

Billing Code: 97750 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97750
Insurance Median: $33
Cash Discount Price: $35
vs. Medicare Baseline: 0.98x Medicare

The contracted insurance negotiated median rate for a Physical therapy (functional capacity test) at Ascension St Vincent's Clay County is $33. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $35. Compared to the federal Medicare reimbursement reference rate of $33.73, this hospital’s rate is 0.98x the Medicare baseline. Located in 1670 St Vincents Way, Middleburg, FL.

Cash / Self-Pay

$35

Average discount available for prompt cash payment at this facility.

Insurance Median

$33

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: $35 (104%)

Insurance Median: $33 (98%)

Cash: $35 (104% of Medicare)

Ins. Median: $33 (98% 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	$31 - $81	92%
Bc Advantage Mcr Replacement	$32	95%
Blue Cross Blue Shield	$32	95%
Community Hospice	$32	95%
Coventry Mcr Replacement Hmo	$32	95%
Haven Hospice	$32	95%
Medicare (plans)	$32 - $33	95%
Research Study Encore Borland-Groover	$32	95%
Veterans Administration	$32	95%
Wellcare	$32	95%
Aetna	$33 - $66	98%
Careplus Mcr Replacement	$33	98%
Cigna	$33	98%
UnitedHealthcare	$33	98%
Inmate Health Care	$40	119%
Bright Health	$44 - $47	130%
Smarthealth	$45	133%
Oscar Health Plan	$52	154%
Employer Direct Healthcare	$57	169%
90 Degree Benefits	$58	172%
Avmed Exchange	$58	172%
Molina Exchange	$60	178%
Occunet	$60 - $73	178%
Ambetter / Centene	$61	181%

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 $35.
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 Ascension St Vincent's Clay County 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.