CMS Price Transparency Data

Physical therapy (functional capacity test)

Facility: Atrium Health Cleveland

Billing Code: 97750 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97750
Insurance Median: $37
Cash Discount Price: $42
vs. Medicare Baseline: 1.10x Medicare

The contracted insurance negotiated median rate for a Physical therapy (functional capacity test) at Atrium Health Cleveland is $37. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $42. Compared to the federal Medicare reimbursement reference rate of $33.73, this hospital’s rate is 1.10x the Medicare baseline. Located in 201 E Grover St, Shelby, NC.

Cash / Self-Pay

$42

Average discount available for prompt cash payment at this facility.

Insurance Median

$37

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: $42 (125%)

Insurance Median: $37 (110%)

Cash: $42 (125% of Medicare)

Ins. Median: $37 (110% 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
Amerihealth Caritas	$12 - $23	36%
Carolina Complete Health	$12 - $23	36%
Healthy Blue	$12 - $23	36%
Partners	$12 - $23	36%
Vaya	$12 - $23	36%
Wellcare	$12 - $23	36%
Alliance	$13 - $24	39%
Trillium	$13 - $23	39%
UnitedHealthcare	$18 - $45	53%
Aetna	$22 - $65	65%
Blue Cross Blue Shield	$26 - $35	77%
Ambetter / Centene	$27 - $31	80%
Cigna	$32 - $68	95%
Humana	$32	95%
Employers Health Network	$37	110%
Physician Reach Out	$42	125%
Medcost	$47 - $56	139%
Magellan	$51	151%
Gmmi	$55	163%
Quik Trip	$55	163%
Carolina Behavioral Health	$61 - $68	181%
Healthgram	$68	202%
Choicecare	$69	205%
First Health	$72	213%
Lifesynch Community Choice Care	$72	213%
Private Health Care Systems	$76	225%
Beechstreet	$78	231%
Multiplan	$80	237%

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 $42.
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 Atrium Health Cleveland 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.