CMS Price Transparency Data

Physical therapy (functional capacity test)

Facility: Carlsbad Medical Center

Billing Code: 97750 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97750
Insurance Median: $310
Cash Discount Price: $90
vs. Medicare Baseline: 9.19x Medicare

The contracted insurance negotiated median rate for a Physical therapy (functional capacity test) at Carlsbad Medical Center is $310. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $90. Compared to the federal Medicare reimbursement reference rate of $33.73, this hospital’s rate is 9.19x the Medicare baseline. Located in 2430 West Pierce Street, Carlsbad, NM.

Cash / Self-Pay

$90

Average discount available for prompt cash payment at this facility.

Insurance Median

$310

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: $90 (267%)

Insurance Median: $310 (919%)

Cash: $90 (267% of Medicare)

Ins. Median: $310 (919% 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 919% of the Medicare baseline (a markup of 819%). 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
Blue Cross Blue Shield	$32 - $543	95%
Department Of Veterans Affairs	$32	95%
Medicare (plans)	$32	95%
Node Molina Mcr Adv	$32	95%
Node Va	$32	95%
Presbyterian	$32 - $434	95%
Tricare	$32	95%
Triwest	$32	95%
Veterans Eval Services	$32	95%
Node Choice Care Mcr Adv	$33	98%
Node Devoted Health Mcr Adv	$33	98%
UnitedHealthcare	$33 - $398	98%
Medicaid / KanCare	$35 - $37	104%
Wexford Health	$40	119%
Us Department Of Labor	$50	148%
Self Pay	$60 - $120	178%
Work Comp Nm	$68 - $216	202%
Node Molina Health Exchange	$88	261%
Nm Health Connection	$129	382%
Eddy County Detention	$300	889%
Capstar	$331	981%
Zelis	$379 - $505	1124%
Omni Network	$391	1159%
Cigna	$417 - $504	1236%
Choice Care	$421	1248%
Ccn First Health	$481	1426%
Healthsmart	$487 - $517	1444%
Aetna	$505	1497%
Multiplan	$505	1497%
Medical Control Inc	$559	1657%

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 $90.
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 Carlsbad Medical Center 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.