CMS Price Transparency Data

Physical therapy (functional capacity test)

Facility: Southwest General Health Center

Billing Code: 97750 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97750
Insurance Median: $88
Cash Discount Price: $131
vs. Medicare Baseline: 2.61x Medicare

The contracted insurance negotiated median rate for a Physical therapy (functional capacity test) at Southwest General Health Center is $88. 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 2.61x the Medicare baseline. Located in 18697 Bagley Road, Middleburg Heights, OH.

Cash / Self-Pay

$131

Average discount available for prompt cash payment at this facility.

Insurance Median

$88

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: $88 (261%)

Cash: $131 (388% of Medicare)

Ins. Median: $88 (261% 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 261% of the Medicare baseline (a markup of 161%). 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
Medical Mutual	$18 - $20	53%
Medical Mutual-Ohio	$18	53%
Healthsmart	$41 - $72	122%
Health Design Plus	$47 - $83	139%
Humana	$50 - $116	148%
Clarity Health	$51 - $90	151%
Healthspan	$51 - $90	151%
Healthsmart Preferred	$57 - $101	169%
Buckeye	$58 - $116	172%
Molina	$58 - $116	172%
Ohio Health Choice Plus	$61 - $108	181%
Aetna	$69 - $121	205%
Summacare	$69 - $121	205%
UnitedHealthcare	$69 - $121	205%
Coventry	$88 - $155	261%
First Health	$88 - $155	261%
Ohio Health Choice	$98 - $173	291%
Private Healthare Systems	$102 - $179	302%
Amerihealth Caritas	$116	344%
Blue Cross Blue Shield	$116	344%
Caresource	$116	344%
Cigna	$184	546%

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 Southwest General Health 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.