CMS Price Transparency Data

Physical therapy (functional capacity test)

Facility: Blue Ridge Regional Hospital

Billing Code: 97750 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97750
Insurance Median: $50
Cash Discount Price: $127
vs. Medicare Baseline: 1.48x Medicare

The contracted insurance negotiated median rate for a Physical therapy (functional capacity test) at Blue Ridge Regional Hospital is $50. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $127. Compared to the federal Medicare reimbursement reference rate of $33.73, this hospital’s rate is 1.48x the Medicare baseline. Located in 125 Hospital Drive, Spruce Pine, NC.

Cash / Self-Pay

$127

Average discount available for prompt cash payment at this facility.

Insurance Median

$50

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: $127 (377%)

Insurance Median: $50 (148%)

Cash: $127 (377% of Medicare)

Ins. Median: $50 (148% 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
Blue Cross Blue Shield	$18 - $24	53%
United	$19 - $67	56%
Wellcare	$19 - $24	56%
Amerihealth	$20 - $25	59%
Partners Health Management	$20 - $25	59%
Vaya Health	$20 - $25	59%
Aetna	$23 - $102	68%
Apex Health	$23 - $28	68%
Cigna	$38 - $58	113%
Amerihealth Caritas	$42 - $52	125%
Caresource	$50 - $62	148%
Medcost	$52 - $73	154%
Magellan	$68 - $84	202%
Magellan Behavioral Health	$68 - $84	202%
Multiplan	$90 - $113	267%
Avalon Administrative Services	$96 - $120	285%
Prime Health	$99 - $127	294%

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 $127.
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 Blue Ridge Regional 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.