CMS Price Transparency Data

Physical therapy (functional capacity test)

Facility: Mon Health Medical Center

Billing Code: 97750 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97750
Insurance Median: $54
Cash Discount Price: $97
vs. Medicare Baseline: 1.60x Medicare

The contracted insurance negotiated median rate for a Physical therapy (functional capacity test) at Mon Health Medical Center is $54. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $97. Compared to the federal Medicare reimbursement reference rate of $33.73, this hospital’s rate is 1.60x the Medicare baseline. Located in 1200 Jd Anderson Drive, Morgantown, WV.

Cash / Self-Pay

$97

Average discount available for prompt cash payment at this facility.

Insurance Median

$54

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: $97 (288%)

Insurance Median: $54 (160%)

Cash: $97 (288% of Medicare)

Ins. Median: $54 (160% 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
Gateway_Health_Plan	$17	50%
Unison_Plan	$17	50%
Upmc__Plan	$25 - $310	74%
Maryland_Physicians_Care_Plan	$26 - $224	77%
Geha_Plan	$27 - $310	80%
Zelis_Other_Plan	$27 - $54	80%
Aetna	$31 - $256	92%
Blue Cross Blue Shield	$31 - $155	92%
Health_South_Mountain_View_Plan	$31	92%
Humana	$31 - $288	92%
Medicare (plans)	$31	92%
Paramount_Elite_Plan	$31	92%
Uhc_Onenet_Ppo_Plan	$31 - $310	92%
Uhc_Options_Ppo_Plan	$31 - $297	92%
Uhc_Plan	$31 - $288	92%
Uhc_Va_Plan	$31	92%
Umwa_Plan	$31	92%
Zelis_Group_Health_Plan	$31 - $54	92%
The_Health_Plan_Peia_Plan	$37	110%
Acpn_Plan	$62 - $288	184%
Seven_Corners_Plan	$63	187%
The_Health_Plan_Murray_Energy_Commercial_Aso_Plan	$85 - $256	252%
The_Health_Plan_Plan	$275	815%
Cigna	$288	854%
Mon_County_Commission_Plan	$288	854%
Health_Payors_Organization_Plan	$294	872%
Multiplan_Phcs_Plan	$304	901%
Mutual_Of_Omaha_Plan	$304	901%
Three_Rivers_Plan	$310	919%

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 $97.
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 Mon Health 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.