CMS Price Transparency Data

Physical therapy (functional capacity test)

Facility: The Women's Hospital

Billing Code: 97750 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97750
Insurance Median: $32
Cash Discount Price: $34
vs. Medicare Baseline: 0.95x Medicare

The contracted insurance negotiated median rate for a Physical therapy (functional capacity test) at The Women's Hospital is $32. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $34. Compared to the federal Medicare reimbursement reference rate of $33.73, this hospital’s rate is 0.95x the Medicare baseline. Located in 4199 Gateway Blvd, Newburgh, IN.

Cash / Self-Pay

$34

Average discount available for prompt cash payment at this facility.

Insurance Median

$32

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: $34 (101%)

Insurance Median: $32 (95%)

Cash: $34 (101% of Medicare)

Ins. Median: $32 (95% 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	$20 - $59	59%
Humana	$20 - $32	59%
Passport Molina Ky	$20	59%
UnitedHealthcare	$20 - $32	59%
Wellcare Ky	$20 - $32	59%
Blue Cross Blue Shield	$22 - $32	65%
Meridian Health Il	$22 - $32	65%
Molina Il	$22 - $32	65%
Caresource	$32	95%
Caresource Hip	$32	95%
Caresource In	$32	95%
Iu Health	$32	95%
Mdwise Hip	$32	95%
Mhs	$32	95%
Mhs Behavioral	$32	95%
Molina Ky	$32	95%
Molina Ky Dual	$32	95%
Alliance Coal	$33	98%
Amish	$34	101%
Self Pay	$34	101%
Ambetter / Centene	$36	107%
Immergrun	$38	113%
Caresource Marketplace (Just4Me)	$41	122%
Patoka Valley Health Care (80/20 Plan)	$41	122%
Patoka Valley Health Care (90/10 Plan)	$41	122%
Encorecombined	$42	125%
Encoreprime	$42	125%
Hst	$43	127%
Allied National/Zelis - Freedom Plan	$44	130%
Claimdoc	$46	136%
Chamber Care	$48	142%
One Care	$48	142%
Hope Trust	$51	151%
Noncontracted	$51	151%
Center Care	$59	175%
Cigna	$59	175%
Claritev (Formerly Phcs/Mulitplan)	$59	175%
First Health/Coventry	$59	175%
Healthlink	$59	175%
Sagamore	$59	175%

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 $34.
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 The Women's 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.