CMS Price Transparency Data

Physical therapy (functional capacity test)

Facility: Piedmont Macon North Hospital

Billing Code: 97750 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97750
Insurance Median: $266
Cash Discount Price: $104
vs. Medicare Baseline: 7.89x Medicare

The contracted insurance negotiated median rate for a Physical therapy (functional capacity test) at Piedmont Macon North Hospital is $266. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $104. Compared to the federal Medicare reimbursement reference rate of $33.73, this hospital’s rate is 7.89x the Medicare baseline. Located in 400 Charter Boulevard, Macon, GA.

Cash / Self-Pay

$104

Average discount available for prompt cash payment at this facility.

Insurance Median

$266

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: $104 (308%)

Insurance Median: $266 (789%)

Cash: $104 (308% of Medicare)

Ins. Median: $266 (789% 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 789% of the Medicare baseline (a markup of 689%). 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
Medicaid / KanCare	$31 - $57	92%
Blue Cross Blue Shield	$194 - $354	575%
Phcs [10601]	$202 - $212	599%
UnitedHealthcare	$215 - $331	637%
Industry Buying Group [10840]	$219 - $230	649%
First Health [10303]	$235 - $248	697%
Novanet [10819]	$252 - $266	747%
Beechstreet [10800]	$269 - $283	798%
Multiplan [10600]	$303 - $319	898%
Aetna	$336 - $354	996%
Cigna	$336 - $354	996%

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 $104.
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 Piedmont Macon North 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.