CMS Price Transparency Data

Physical therapy (functional capacity test)

Facility: UMass Memorial Healthalliance Hospitals

Billing Code: 97750 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97750
Insurance Median: $77
Cash Discount Price: $146
vs. Medicare Baseline: 2.28x Medicare

The contracted insurance negotiated median rate for a Physical therapy (functional capacity test) at UMass Memorial Healthalliance Hospitals is $77. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $146. Compared to the federal Medicare reimbursement reference rate of $33.73, this hospital’s rate is 2.28x the Medicare baseline. Located in 60 Hospital Road, Leominster, MA.

Cash / Self-Pay

$146

Average discount available for prompt cash payment at this facility.

Insurance Median

$77

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: $146 (433%)

Insurance Median: $77 (228%)

Cash: $146 (433% of Medicare)

Ins. Median: $77 (228% 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 228% of the Medicare baseline (a markup of 128%). 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
Workers Compensation [20501]	$24	71%
Champva [11001]	$26	77%
Cigna	$35 - $98	104%
Correctional Care [11003]	$35 - $55	104%
Institution [10406]	$35 - $77	104%
Medicare (plans)	$35	104%
Tufts Dual [10111]	$35	104%
Tufts Us Family [11203]	$35	104%
Blue Cross Blue Shield	$36 - $249	107%
Aetna	$37 - $95	110%
Commonwealth Care Mcr [10115]	$37	110%
Fallon Mcr Supp [20202]	$37	110%
Harvard Pilgrim Mcr [10106]	$37	110%
Mgb Mcr [10124]	$37	110%
Tufts Mcr [10112]	$37	110%
UnitedHealthcare	$37 - $146	110%
Senior Whole Health [10110]	$38	113%
Tufts Connectorcare [10507]	$60	178%
Medicaid / KanCare	$76 - $97	225%
Wellpoint [11112]	$76	225%
Hne [11108]	$81	240%
Tufts [11201]	$89	264%
Fallon Connectorcare [10503]	$105	311%
First Health Network [11120]	$110	326%
Multiplan [11109]	$110	326%
Connecticare [11105]	$146	433%
Fallon Carelon Hlth [28]	$146	433%
Fallon Mcaid Carelon Hlth [29]	$146	433%
Grants [20507]	$146	433%
Harvard Pilgrim [10701]	$185 - $222	548%
Hsno/Free Care [10801]	$294	872%

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 $146.
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 UMass Memorial Healthalliance Hospitals 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.