CMS Price Transparency Data

Physical therapy (functional capacity test)

Facility: Licking Memorial Hospital

Billing Code: 97750 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97750
Insurance Median: $147
Cash Discount Price: $179
vs. Medicare Baseline: 4.36x Medicare

The contracted insurance negotiated median rate for a Physical therapy (functional capacity test) at Licking Memorial Hospital is $147. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $179. Compared to the federal Medicare reimbursement reference rate of $33.73, this hospital’s rate is 4.36x the Medicare baseline. Located in 1320 West Main Street, Newark, OH.

Cash / Self-Pay

$179

Average discount available for prompt cash payment at this facility.

Insurance Median

$147

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: $179 (531%)

Insurance Median: $147 (436%)

Cash: $179 (531% of Medicare)

Ins. Median: $147 (436% 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 436% of the Medicare baseline (a markup of 336%). 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
Aetna	$31 - $148	92%
Blue Cross Blue Shield	$31 - $154	92%
Champva [500001]	$31	92%
Cigna	$31 - $161	92%
Humana	$31 - $174	92%
Medicare (plans)	$31	92%
Tricare	$31	92%
UnitedHealthcare	$31 - $152	92%
Veterans Administration [100068]	$31	92%
Wellcare By Allwell [450104]	$31	92%
Molina Marketplace [100106]	$50	148%
Medical Mutual [100114]	$99 - $149	294%
Medben [700068]	$125 - $176	371%
Benicomp [70090]	$134	397%
Consociate Health 6 Degrees [100059]	$143	424%
Consociate Health [100029]	$143	424%
Allied Benefit Systems [100015]	$147	436%
Geha [100039]	$147	436%
Gravie Administrative Services [100165]	$147	436%
Meritain [100063]	$147	436%
Optima [700069]	$147	436%
Trustmark Small Business Benefits [100263]	$147	436%
Webtpa [100127]	$147	436%
Healthscope [100157]	$152	451%
Surest [100016]	$152	451%
United Medical Resources [700071]	$152	451%
American Postal Workers [100089]	$161	477%
Antidote Health Plan Of Ohio [70006803]	$161	477%
Coresource [100002]	$161 - $179	477%
Great West Life [700064]	$161	477%
National Association Of Letter Carriers [100067]	$161	477%
Ohio Healthy Luminare Health [100264]	$161	477%
Ohio Healthy [100255]	$161	477%
Ohio Ppo Connect [70006801]	$161	477%
Osu Prime Care [100254]	$161	477%
Quality Care Partners [70006802]	$161	477%
The Health Plan [100261]	$161	477%
Wellfleet Group, Llc [100164]	$161	477%
Coventry [100010]	$165	489%
Pan American Life [700070]	$165	489%
Ohio Health Choice [100109]	$172	510%
Administrative Concepts [100006]	$174	516%
Carefactor [100087]	$174	516%
Philadelphia American Life [100260]	$174 - $179	516%
Reliance Standard-Asrm [100258]	$174	516%

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 $179.
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 Licking 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.