CMS Price Transparency Data

Physical therapy (functional capacity test)

Facility: Munson Healthcare Otsego Memorial Hospital

Billing Code: 97750 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97750
Insurance Median: $74
Cash Discount Price: $94
vs. Medicare Baseline: 2.19x Medicare

The contracted insurance negotiated median rate for a Physical therapy (functional capacity test) at Munson Healthcare Otsego Memorial Hospital is $74. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $94. Compared to the federal Medicare reimbursement reference rate of $33.73, this hospital’s rate is 2.19x the Medicare baseline. Located in 825 N Center Ave, Gaylord, MI.

Cash / Self-Pay

$94

Average discount available for prompt cash payment at this facility.

Insurance Median

$74

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: $94 (279%)

Insurance Median: $74 (219%)

Cash: $94 (279% of Medicare)

Ins. Median: $74 (219% 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 219% of the Medicare baseline (a markup of 119%). 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
Blue Cross Blue Shield	$17 - $74	50%
Mclaren Health Plan	$17 - $99	50%
Meridian	$17	50%
Molina	$17 - $35	50%
Priority Health	$17 - $85	50%
UnitedHealthcare	$17 - $95	50%
Aetna	$32 - $96	95%
Blue Care Network	$32	95%
Hap (Health Alliance Plan)	$32 - $94	95%
Humana	$32	95%
Medicare (plans)	$32	95%
Michigan Amish Medical Board	$32	95%
Northern Michigan Mennonite Group	$32	95%
Asr Physicians Care Network	$48 - $94	142%
Nomi Health	$51 - $94	151%
Cigna	$53 - $85	157%
Employee Benefit Logistics	$55	163%
Hospice Of Michigan	$62 - $71	184%
Munson Hospice	$72 - $852	213%
Enterprise Group Planning/Employee Benefit Plan	$82 - $94	243%
Cofinity	$88 - $100	261%
Provider Network Of America/Hawaii Mainland Administrative Group Health	$88 - $100	261%
Three Rivers Provider Network	$88 - $100	261%

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 $94.
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 Munson Healthcare Otsego Memorial 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.