CMS Price Transparency Data

Physical therapy (functional capacity test)

Facility: Atrium Health Navicent the Medical Center

Billing Code: 97750 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97750
Insurance Median: $52
Cash Discount Price: $78
vs. Medicare Baseline: 1.54x Medicare

The contracted insurance negotiated median rate for a Physical therapy (functional capacity test) at Atrium Health Navicent the Medical Center is $52. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $78. Compared to the federal Medicare reimbursement reference rate of $33.73, this hospital’s rate is 1.54x the Medicare baseline. Located in 777 Hemlock Street, Macon, GA.

Cash / Self-Pay

$78

Average discount available for prompt cash payment at this facility.

Insurance Median

$52

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: $78 (231%)

Insurance Median: $52 (154%)

Cash: $78 (231% of Medicare)

Ins. Median: $52 (154% 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
Aetna	$31 - $108	92%
Blue Cross Blue Shield	$31 - $74	92%
Georgia Health Advantage	$31	92%
Humana	$31 - $107	92%
Pruitt Health	$31 - $33	92%
UnitedHealthcare	$31 - $294	92%
Care Source	$32	95%
Clover	$32	95%
Eon Health	$32	95%
Alliant	$37 - $69	110%
Ambetter / Centene	$42 - $80	125%
Cigna	$43 - $266	127%
Securehealth	$52 - $55	154%
Kaiser	$57 - $101	169%
Multiplan	$101 - $125	299%
Ibg	$110	326%
Novanet	$125	371%
Three Rivers Provider Network	$133	394%
Beechstreet	$145	430%

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 $78.
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 Atrium Health Navicent the Medical 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.