CMS Price Transparency Data

Physical therapy (functional capacity test)

Facility: Henry Ford Macomb Hospital

Billing Code: 97750 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97750
Insurance Median: $33
Cash Discount Price: Unavailable
vs. Medicare Baseline: 0.98x Medicare

The contracted insurance negotiated median rate for a Physical therapy (functional capacity test) at Henry Ford Macomb Hospital is $33. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $33.73, this hospital’s rate is 0.98x the Medicare baseline. Located in 15855 Nineteen Mile Rd, Clinton Township, MI.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$33

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%)

Insurance Median: $33 (98%)

Ins. Median: $33 (98% 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	$18 - $33	53%
Blue Cross Blue Shield	$18 - $53	53%
Hap	$18 - $49	53%
Mclaren	$18	53%
Meridian Health Plan Of Mi	$18	53%
Priority Health	$18 - $66	53%
Molina	$19 - $37	56%
UnitedHealthcare	$22 - $33	65%
Humana	$27 - $44	80%
Pace Se Mi	$32	95%
Amerihealth Michigan	$33	98%
Bcn	$33 - $34	98%
Cca Health Mi	$33	98%
Health Alliance Plan Of Michigan	$33	98%
Mclaren Health Plan Inc.	$33	98%
Meridian	$33	98%
Mount Carmel Health Plan	$33	98%
Priority	$33	98%
United Behavioral Health, Inc.	$33	98%
Wellcare Ma	$33	98%
Wellcare	$34	101%
Vitalcore Physicians Group Of Mi	$43	127%
Cigna	$46	136%

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 $X.
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 Henry Ford Macomb 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.