CMS Price Transparency Data

Physical therapy (functional capacity test)

Facility: Highlands Cashiers Hospital

Billing Code: 97750 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97750
Insurance Median: $55
Cash Discount Price: $131
vs. Medicare Baseline: 1.63x Medicare

The contracted insurance negotiated median rate for a Physical therapy (functional capacity test) at Highlands Cashiers Hospital is $55. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $131. Compared to the federal Medicare reimbursement reference rate of $33.73, this hospital’s rate is 1.63x the Medicare baseline. Located in 190 Hospital Drive, Highlands, NC.

Cash / Self-Pay

$131

Average discount available for prompt cash payment at this facility.

Insurance Median

$55

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: $131 (388%)

Insurance Median: $55 (163%)

Cash: $131 (388% of Medicare)

Ins. Median: $55 (163% 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
Apex Health	$23 - $29	68%
Cigna	$38 - $65	113%
Blue Cross Blue Shield	$39 - $53	116%
United	$40 - $88	119%
Amerihealth	$41 - $52	122%
Partners Health Management	$41 - $52	122%
Vaya Health	$41 - $52	122%
Wellcare	$41 - $51	122%
Amerihealth Caritas	$44 - $55	130%
Caresource	$51 - $64	151%
Medcost	$54 - $82	160%
Aetna	$56 - $106	166%
Magellan	$69 - $88	205%
Magellan Behavioral Health	$69 - $88	205%
Multiplan	$93 - $117	276%
Avalon Administrative Services	$98 - $124	291%
Prime Health	$102 - $131	302%

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 $131.
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 Highlands Cashiers 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.