CMS Price Transparency Data

Physical therapy (functional capacity test)

Facility: American Fork Hospital

Billing Code: 97750 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97750
Insurance Median: $95
Cash Discount Price: $116
vs. Medicare Baseline: 2.82x Medicare

The contracted insurance negotiated median rate for a Physical therapy (functional capacity test) at American Fork Hospital is $95. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $116. Compared to the federal Medicare reimbursement reference rate of $33.73, this hospital’s rate is 2.82x the Medicare baseline. Located in 170 North 1100 East, American Fork, UT.

Cash / Self-Pay

$116

Average discount available for prompt cash payment at this facility.

Insurance Median

$95

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: $116 (344%)

Insurance Median: $95 (282%)

Cash: $116 (344% of Medicare)

Ins. Median: $95 (282% 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 282% of the Medicare baseline (a markup of 182%). 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
Health Plan Of Nevada	$27 - $33	80%
Healthy U	$27 - $33	80%
Selecthealth	$27 - $90	80%
Aetna	$33 - $131	98%
American Health	$33 - $34	98%
Blue Cross Blue Shield	$33 - $117	98%
Health Partners Of Nevada	$33	98%
Humana	$33 - $34	98%
Molina	$33 - $36	98%
Triwest	$33	98%
UnitedHealthcare	$33 - $131	98%
Donor Connect	$37	110%
Intermountain Caregiver Plan	$65 - $86	193%
Emi	$83	246%
Deseret Mutual	$89	264%
Cigna	$97 - $131	288%
Awh Connected	$98 - $99	291%
Emi Health	$107	317%
Pehp	$107 - $137	317%
Byu Risk Management	$108 - $112	320%
Corporation Of The President	$108 - $112	320%
Wcf Insurance	$108 - $112	320%
Byu Athletics	$111	329%
Campbell Scientific	$111	329%
Corvel Corporation	$111	329%
Franklin County	$111	329%
Ifit	$111	329%
Juniper Systems	$111	329%
Lw Miller	$111	329%
Tanner Llc	$111	329%
Utah Tech	$111	329%
Injury Care Of Nevada	$116	344%
Managed Care Admin	$120	356%
Prodegi Corp Benefit	$126	374%
Uofu	$126	374%
Springtide	$128	379%
Global Excel	$131	388%
Medcare International	$131	388%
Motivhealth	$131	388%
Wise Network	$131	388%
Hygeia Corporation	$139	412%

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 $116.
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 American Fork 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.