CMS Price Transparency Data

Physical therapy (functional capacity test)

Facility: Middlesboro Arh Hospital

Billing Code: 97750 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97750
Insurance Median: $32
Cash Discount Price: $50
vs. Medicare Baseline: 0.95x Medicare

The contracted insurance negotiated median rate for a Physical therapy (functional capacity test) at Middlesboro Arh Hospital is $32. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $50. Compared to the federal Medicare reimbursement reference rate of $33.73, this hospital’s rate is 0.95x the Medicare baseline. Located in 3600 West Cumberland Avenue, Middlesboro, KY.

Cash / Self-Pay

$50

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: $50 (148%)

Insurance Median: $32 (95%)

Cash: $50 (148% 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	$15 - $78	44%
Blue Cross Blue Shield	$15 - $41	44%
Humana	$15 - $32	44%
Passport Molina	$15	44%
Wellcare Of Kentucky	$21 - $32	62%
UnitedHealthcare	$32 - $63	95%
Caresoure Kentucky	$50	148%

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 $50.
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 Middlesboro Arh 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.