CMS Price Transparency Data

Physical therapy (functional capacity test)

Facility: Dekalb Community Hospital

Billing Code: 97750 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97750
Insurance Median: $31
Cash Discount Price: $35
vs. Medicare Baseline: 0.92x Medicare

The contracted insurance negotiated median rate for a Physical therapy (functional capacity test) at Dekalb Community Hospital is $31. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $35. Compared to the federal Medicare reimbursement reference rate of $33.73, this hospital’s rate is 0.92x the Medicare baseline. Located in 520 W Main St, Smithville, TN.

Cash / Self-Pay

$35

Average discount available for prompt cash payment at this facility.

Insurance Median

$31

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: $35 (104%)

Insurance Median: $31 (92%)

Cash: $35 (104% of Medicare)

Ins. Median: $31 (92% 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.

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	$23 - $72	68%
Point Comfort Underwriters	$28	83%
Community Plan	$29	86%
Amerigroup Mcr Replacement	$31	92%
Ascension Complete	$31	92%
Centurion Of Tn	$31	92%
Covid Uninsured Test Fund	$31	92%
Healthspring Mcr Replacement	$31	92%
Humana	$31	92%
Medicare (plans)	$31	92%
Nhc Advantage	$31	92%
UnitedHealthcare	$31	92%
Aetna	$32	95%
Ambetter / Centene	$41	122%
Cigna	$44 - $48	130%
Oscar Health	$44	130%
Smart Health	$44	130%

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 $35.
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 Dekalb Community 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.