CMS Price Transparency Data

Physical therapy (functional capacity test)

Facility: Witham Health Services

Billing Code: 97750 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97750
Insurance Median: $114
Cash Discount Price: $96
vs. Medicare Baseline: 3.38x Medicare

The contracted insurance negotiated median rate for a Physical therapy (functional capacity test) at Witham Health Services is $114. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $96. Compared to the federal Medicare reimbursement reference rate of $33.73, this hospital’s rate is 3.38x the Medicare baseline. Located in 2605 N Lebanon St, Lebanon, IN.

Cash / Self-Pay

$96

Average discount available for prompt cash payment at this facility.

Insurance Median

$114

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: $96 (285%)

Insurance Median: $114 (338%)

Cash: $96 (285% of Medicare)

Ins. Median: $114 (338% 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 338% of the Medicare baseline (a markup of 238%). 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
Blue Cross Blue Shield	$32 - $146	95%
Mdwise Health In-All Plans	$32	95%
Aetna	$33 - $108	98%
Caresource Mcr Adv	$33	98%
Caresource Indiana Marketplace-All Other Plans	$61	181%
UnitedHealthcare	$104 - $114	308%
Phcs/Multiplan-All Plans	$118 - $133	350%
Sagamore-All Plans	$120 - $134	356%
Beech Street-All Plans	$122 - $137	362%
Encore-All Plans	$124 - $139	368%
Humana	$124 - $136	368%
Mhs Comml Exch-All Plans	$325 - $365	964%

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 $96.
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 Witham Health Services 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.