CMS Price Transparency Data

Physical therapy (functional capacity test)

Facility: Dickenson Community Hospital

Billing Code: 97750 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97750
Insurance Median: $47
Cash Discount Price: $32
vs. Medicare Baseline: 1.39x Medicare

The contracted insurance negotiated median rate for a Physical therapy (functional capacity test) at Dickenson Community Hospital is $47. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $32. Compared to the federal Medicare reimbursement reference rate of $33.73, this hospital’s rate is 1.39x the Medicare baseline. Located in 312 Hospital Drive, Clintwood, VA.

Cash / Self-Pay

$32

Average discount available for prompt cash payment at this facility.

Insurance Median

$47

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: $32 (95%)

Insurance Median: $47 (139%)

Cash: $32 (95% of Medicare)

Ins. Median: $47 (139% 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	$33 - $116	98%
Aetna	$41 - $110	122%
Amerigroup	$41	122%
Managed Medicaire	$41	122%
Medicare (plans)	$41	122%
Sentara Health	$41 - $51	122%
United Mine Workers Of America	$41	122%
UnitedHealthcare	$41 - $137	122%
Humana	$42	125%
Cigna	$43 - $66	127%
Devoted Health Plan	$43	127%
Molina Healthcare	$43 - $67	127%
Nhc Advantage	$43	127%
Medcost	$48	142%
Ambetter / Centene	$51	151%
Optima Health	$64	190%
Seven Corners, Inc.	$137	406%

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 $32.
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 Dickenson 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.