CMS Price Transparency Data

Physical therapy (functional capacity test)

Facility: Alice Peck Day Memorial Hospital

Billing Code: 97750 (CPT)

The BaseRate · fair price medium confidence
A fair price for this
$104
about 3.1× the $34 Medicare rate · typically $22–$165
modeled estimate · not a bill or quote
What this hospital charges insurers
$17
Below the fair price — a good deal
about $87 under the fair price · 0.5× Medicare
Medicare pays $34 Fair price $104 This hospital $17 Cash price $75 Hospital's list price $140

How we calculate the fair BaseRate →

How this hospital compares to other NH hospitals

Lowest price of the 9 NH hospitals we have prices for — a strong deal.

Cheapest $17 Priciest $41

Black dot = this hospital, among the 9 NH hospitals with a price for this procedure. Full list below.

⚠ The cash price looks unusually high next to the insurance price — it may be the full list price, not a real cash discount. Call to confirm the self-pay rate.

A fair price for a Physical therapy (functional capacity test) is about $104 (about 3.1× the $34 Medicare rate). Alice Peck Day Memorial Hospital charges insurers about $17, or about $75 in cash — below the fair price — a good deal. Located in Lebanon, NH.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

5 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Cigna✓ Humana Kaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company Price range vs. Medicare
UnitedHealthcaremajor $90 - $112 267%
Blue Cross Blue Shieldmajor $62 - $138 184%
Aetnamajor $112 - $147 332%
Cignamajor $96 - $127 285%
Humanamajor $130 - $161 385%
Ambetter (Centene) $17 50%
Harvard Pilgrim $78 - $134 231%
MVP Health Care $114 - $141 338%
Tufts Health Plan $92 - $114 273%
+ 4 smaller / regional plans $18 - $120
Government programs also on file: Medicaid.

Self-Pay How to get the cash price

Insurance Before you use insurance

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

Enter your details and press estimate to compare.

Facility Profile & Credentials

  • Address: 10 Alice Peck Day Drive, Lebanon, NH 03766
  • CMS Rating: ★★★★☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Critical Access Hospitals