CMS Price Transparency Data

Physical therapy (functional capacity test)

Facility: Carolinas Medical Center/Behav Health

Billing Code: 97750 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97750
Insurance Median: $40
Cash Discount Price: $42
vs. Medicare Baseline: 1.19x Medicare

The contracted insurance negotiated median rate for a Physical therapy (functional capacity test) at Carolinas Medical Center/Behav Health is $40. 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 1.19x the Medicare baseline. Located in 1000 Blythe Blvd, Charlotte, NC.

Cash / Self-Pay

$42

Average discount available for prompt cash payment at this facility.

Insurance Median

$40

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: $40 (119%)

Cash: $42 (125% of Medicare)

Ins. Median: $40 (119% 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	$16 - $62	47%
Blue Cross Blue Shield	$16 - $49	47%
Cigna	$16 - $68	47%
Humana	$16 - $69	47%
Amerihealth Caritas	$18 - $23	53%
Alliance	$19 - $24	56%
Carolina Complete Health	$19 - $85	56%
Healthy Blue	$19 - $23	56%
Partners	$19 - $23	56%
Sandhills	$19	56%
Trillium	$19 - $23	56%
Vaya	$19 - $23	56%
Wellcare	$19 - $23	56%
UnitedHealthcare	$23 - $43	68%
Ambetter / Centene	$25 - $40	74%
Medcost	$26 - $50	77%
Employers Health Network	$37	110%
Ortho Carolina	$40	119%
Physician Reach Out	$42	125%
Magellan	$51	151%
Molina	$53	157%
Gmmi	$55	163%
Quik Trip	$55	163%
Carolina Behavioral Health	$61 - $68	181%
Choicecare	$61 - $63	181%
First Health	$68 - $74	202%
Healthgram	$68	202%
Private Health Care Systems	$68 - $69	202%
Provider Select	$68 - $76	202%
Lifesynch Community Choice Care	$69	205%
Beechstreet	$74	219%
Multiplan	$76	225%

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 Carolinas Medical Center/Behav Health 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.