CMS Price Transparency Data

Physical therapy (functional capacity test)

Facility: Fairview Hospital

Billing Code: 97750 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97750
Insurance Median: $61
Cash Discount Price: $90
vs. Medicare Baseline: 1.81x Medicare

The contracted insurance negotiated median rate for a Physical therapy (functional capacity test) at Fairview Hospital is $61. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $90. Compared to the federal Medicare reimbursement reference rate of $33.73, this hospital’s rate is 1.81x the Medicare baseline. Located in 29 Lewis Avenue, Great Barrington, MA.

Cash / Self-Pay

$90

Average discount available for prompt cash payment at this facility.

Insurance Median

$61

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: $90 (267%)

Insurance Median: $61 (181%)

Cash: $90 (267% of Medicare)

Ins. Median: $61 (181% 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	$25 - $71	74%
Health New England	$26 - $147	77%
Medicaid / KanCare	$26 - $147	77%
Point32Health	$29 - $90	86%
Bmchnp	$30 - $153	89%
Medicare (plans)	$34 - $36	101%
Hospice	$35 - $37	104%
Other Government	$35 - $37	104%
UnitedHealthcare	$35 - $81	104%
Blue Cross Blue Shield	$36 - $80	107%
Commcare Alliance	$36 - $41	107%
Fallon	$36 - $42	107%
Comm Fallon Qhp	$52 - $58	154%
Workers Comp	$60	178%
Allways Nhp	$61	181%
Unicare	$61 - $69	181%
Comm Hne Hmo	$64 - $65	190%
Comm Hne Ppo	$67 - $69	199%
Capital District Physicians' Health Plan	$85	252%
Cigna	$85 - $88	252%
Mvp	$85	252%
Oxford	$85	252%
First Health	$88 - $90	261%
Connecticare	$90	267%
Consolidated Health Plans	$90	267%
Other Commercial	$90	267%
Phcs	$90	267%
Self Pay	$90	267%

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 $90.
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 Fairview 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.