CMS Price Transparency Data
Physical therapy (functional capacity test)
Facility: Mount Carmel Dublin
Billing Code: 97750 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 97750
- Insurance Median: $72
- Cash Discount Price: $100
- vs. Medicare Baseline: 2.13x Medicare
The contracted insurance negotiated median rate for a Physical therapy (functional capacity test) at Mount Carmel Dublin is $72. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $100. Compared to the federal Medicare reimbursement reference rate of $33.73, this hospital’s rate is 2.13x the Medicare baseline. Located in 4105 Emerald Pkwy, Dublin, OH.
Cash / Self-Pay
$100
Average discount available for prompt cash payment at this facility.
Insurance Median
$72
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: $100 (296%)
Insurance Median: $72 (213%)
Cash: $100 (296% of Medicare)
Ins. Median: $72 (213% 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 213% of the Medicare baseline (a markup of 113%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash 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 |
|---|---|---|
| Medicare (plans) | $28 - $34 | 83% |
| Aetna | $32 - $88 | 95% |
| Blue Cross Blue Shield | $32 - $154 | 95% |
| UnitedHealthcare | $32 - $283 | 95% |
| The Health Plan | $33 | 98% |
| Oscar | $53 | 157% |
| Medical Mutual | $59 - $85 | 175% |
| Enterprise Group Planning | $62 | 184% |
| Custom Design Benefits | $68 | 202% |
| Geha | $69 - $283 | 205% |
| Gravie Admin Services | $69 | 205% |
| Healthez | $69 | 205% |
| Meritain | $69 | 205% |
| Webtpa | $69 | 205% |
| Access Health | $72 | 213% |
| Acclaim | $72 | 213% |
| Administrative Concepts | $72 | 213% |
| Allegeant | $72 | 213% |
| Allied Benefit Systems | $72 | 213% |
| American Family | $72 | 213% |
| American Healthcare Alliance | $72 | 213% |
| American National | $72 | 213% |
| American Republic | $72 | 213% |
| Amerihealth | $72 | 213% |
| Aultcare | $72 | 213% |
| Automated Benefit Services | $72 | 213% |
| Auxiant | $72 | 213% |
| Benefit Administrative Systems,Llc | $72 | 213% |
| Boon Chapman | $72 | 213% |
| Cam Administrative Services | $72 | 213% |
| Christian Brother Services | $72 | 213% |
| Christian Brothers Holy Cross | $72 | 213% |
| Claimchoice Adminstrators | $72 | 213% |
| Comprehensive Benefits | $72 | 213% |
| Continental Life Insurance | $72 | 213% |
| Coventry | $72 | 213% |
| Custom Benefit Administrators | $72 | 213% |
| Cypress Benefit Administrators | $72 | 213% |
| Employee Benefit Concepts | $72 | 213% |
| Employee Benefit Management | $72 | 213% |
| Forest County Potawatomi | $72 | 213% |
| Freedom Life Insurance Company | $72 | 213% |
| Group Administrators | $72 | 213% |
| Group Marketing Services | $72 | 213% |
| Group Pension Administrators | $72 | 213% |
| Guardian | $72 | 213% |
| Health America | $72 | 213% |
| Health Choices | $72 | 213% |
| Healthcare Management Admin | $72 | 213% |
| Insight | $72 | 213% |
| Intercare | $72 | 213% |
| Jfp Benefit Management | $72 | 213% |
| Jp Farley Corporation | $72 | 213% |
| Key Benefit Administrator | $72 | 213% |
| Liberty Union Life Assurance Co | $72 | 213% |
| Lucent Health | $72 | 213% |
| Luminare Health | $72 | 213% |
| Magnacare | $72 | 213% |
| Medcost | $72 | 213% |
| Mutual Health Services | $72 | 213% |
| Mutual Of Omaha | $72 | 213% |
| Ncas | $72 | 213% |
| Nippon Life Ins | $72 | 213% |
| Nova | $72 | 213% |
| Painters Union Insurance Fund | $72 | 213% |
| Physicians Mutual | $72 | 213% |
| Plumbers Local 98 Insurance Fund | $72 | 213% |
| Prairie States | $72 | 213% |
| Preferred One | $72 | 213% |
| Primary Physician Care | $72 | 213% |
| Professional Benefit Administrators | $72 | 213% |
| Secureone Preferred United Plans | $72 | 213% |
| Siho Insurance Services | $72 | 213% |
| Sisco Benefits | $72 | 213% |
| The Loomis Company | $72 | 213% |
| Trustmark Small Business Benefits | $72 | 213% |
| U Of M Health Plan | $72 | 213% |
| Unicare | $72 | 213% |
| Unified Group Services | $72 | 213% |
| Us Health And Life | $72 | 213% |
| Valenz | $72 | 213% |
| Varipro | $72 | 213% |
| Wps | $72 | 213% |
| Quality Care Partners | $73 | 216% |
| Humana | $79 - $154 | 234% |
| First Health | $81 | 240% |
| Paramount Hmo | $81 | 240% |
| Western & Southern Financial Group | $85 | 252% |
| Rural Carrier Health Benefit Plan | $88 | 261% |
| Medben | $92 - $116 | 273% |
| Consociate | $94 | 279% |
| Health Ohio Network | $94 | 279% |
| Healthlink Inc | $116 | 344% |
| Medical Benefits Mutual | $116 | 344% |
| Ohio Health Choice | $116 | 344% |
| Ohio Ppo Connect | $116 | 344% |
| Ameriben | $123 | 365% |
| Luminare Health (Detroit) | $123 | 365% |
| Medi Share | $123 | 365% |
| Multiplan | $123 | 365% |
| Ohiohealthy | $123 | 365% |
| Osu Not Independent Choice | $123 | 365% |
| Phcs | $123 | 365% |
| Philadelphia American Life Insurance | $123 | 365% |
| Twin Valley Psychiatric | $123 | 365% |
| Health Smart | $131 | 388% |
| Medicaid / KanCare | $154 | 457% |
| American Postal Workers Secondary | $232 | 688% |
| Cigna | $232 | 688% |
| Health Partners | $232 | 688% |
| Healthgram | $232 | 688% |
| Mvp | $232 | 688% |
| Priority Health | $232 | 688% |