CMS Price Transparency Data

Physical therapy (functional capacity test)

Facility: Ira Davenport Memorial Hospital

Billing Code: 97750 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97750
Insurance Median: $95
Cash Discount Price: $127
vs. Medicare Baseline: 2.82x Medicare

The contracted insurance negotiated median rate for a Physical therapy (functional capacity test) at Ira Davenport Memorial Hospital is $95. 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 2.82x the Medicare baseline. Located in 7571 State Route 54, Bath, NY.

Cash / Self-Pay

$127

Average discount available for prompt cash payment at this facility.

Insurance Median

$95

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: $95 (282%)

Cash: $127 (377% of Medicare)

Ins. Median: $95 (282% 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 282% of the Medicare baseline (a markup of 182%). 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
Empire	$21	62%
Blue Cross Blue Shield	$32 - $481	95%
Humana	$32 - $143	95%
Tricare	$32	95%
Amerihealth Caritas Mcr Adv - All Plans	$33	98%
Fidelis	$46 - $56	136%
Fidelis Care - Exchange - All Plans	$70 - $87	208%
Geisinger - All Plans	$74 - $92	219%
Cigna	$79 - $99	234%
Mvp Health Plan - All Plans	$79 - $99	234%
Independent Health - All Plans	$82 - $103	243%
Upmc - All Plans	$88 - $109	261%
Pomco Inc - All Plans	$91 - $114	270%
Aetna	$95 - $119	282%
UnitedHealthcare	$95 - $133	282%
Emblem Health - All Plans	$112 - $139	332%
Emblem/Ghi	$117	347%
Martins Point - All Plans	$127 - $159	377%
Healthnow - All Plans	$418 - $522	1239%

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 Ira Davenport Memorial 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.