CMS Price Transparency Data

Physical therapy (functional capacity test)

Facility: Adena Fayette Medical Center

Billing Code: 97750 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97750
Insurance Median: $137
Cash Discount Price: $103
vs. Medicare Baseline: 4.06x Medicare

The contracted insurance negotiated median rate for a Physical therapy (functional capacity test) at Adena Fayette Medical Center is $137. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $103. Compared to the federal Medicare reimbursement reference rate of $33.73, this hospital’s rate is 4.06x the Medicare baseline. Located in 1430 Columbus Avenue, Washington Ch, OH.

Cash / Self-Pay

$103

Average discount available for prompt cash payment at this facility.

Insurance Median

$137

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: $103 (305%)

Insurance Median: $137 (406%)

Cash: $103 (305% of Medicare)

Ins. Median: $137 (406% 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 406% of the Medicare baseline (a markup of 306%). 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	$70 - $137	208%
Aetna	$85 - $164	252%
Buckeye Community Health Plan	$85	252%
Humana	$85	252%
Medical Mutual Of Ohio	$85 - $156	252%
Medigold	$85	252%
Molina	$85	252%
Care Source	$86	255%
Molina Marketplace	$93	276%
United Medical Resources Ohcp	$130	385%
UnitedHealthcare	$130 - $131	385%
Cigna	$142	421%
Ohio Ppo Connect	$145	430%
The Health Plan	$145	430%
Care Source Just4Me	$152	451%
Medical Mutual Of Ohio Supermed	$156	462%
First Health	$162	480%
Ohio Health Choice	$164	486%
Multiplan/Private Healthcare Systems	$196	581%
Sidecar Health	$233	691%

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 $103.
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 Adena Fayette 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.