CMS Price Transparency Data

Physical therapy (functional capacity test)

Facility: Lexington Memorial Hospital Inc

Billing Code: 97750 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97750
Insurance Median: $68
Cash Discount Price: $78
vs. Medicare Baseline: 2.02x Medicare

The contracted insurance negotiated median rate for a Physical therapy (functional capacity test) at Lexington Memorial Hospital Inc is $68. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $78. Compared to the federal Medicare reimbursement reference rate of $33.73, this hospital’s rate is 2.02x the Medicare baseline. Located in 250 Hospital Drive Po Box 1817, Lexington, NC.

Cash / Self-Pay

$78

Average discount available for prompt cash payment at this facility.

Insurance Median

$68

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: $78 (231%)

Insurance Median: $68 (202%)

Cash: $78 (231% of Medicare)

Ins. Median: $68 (202% 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 202% of the Medicare baseline (a markup of 102%). 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
Amerihealth	$29 - $43	86%
Carolina Complete	$29	86%
Healthy Blue	$29	86%
Partners	$29	86%
Alliance	$30	89%
Trillium	$30	89%
UnitedHealthcare	$30 - $69	89%
Vaya	$30	89%
Wellcare	$30	89%
Medcost	$34 - $104	101%
Blue Cross Blue Shield	$37 - $59	110%
Aetna	$44 - $143	130%
Ambetter / Centene	$44	130%
Oscar	$50 - $68	148%
Cigna	$67 - $69	199%
Directnet	$92	273%
Healthgram Lexington Home Brands	$112	332%
Healthgram	$124	368%
Private Healthcare Systems	$127	377%
Beechstreet	$136	403%
Humana	$136	403%
Multiplan	$140	415%
National Provider Network	$140	415%

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 $78.
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 Lexington Memorial Hospital Inc 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.