CMS Price Transparency Data

Physical therapy (functional capacity test)

Facility: Mercyone Des Moines Medical Center

Billing Code: 97750 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97750
Insurance Median: $39
Cash Discount Price: $72
vs. Medicare Baseline: 1.16x Medicare

The contracted insurance negotiated median rate for a Physical therapy (functional capacity test) at Mercyone Des Moines Medical Center is $39. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $72. Compared to the federal Medicare reimbursement reference rate of $33.73, this hospital’s rate is 1.16x the Medicare baseline. Located in 1111 6Th Ave, Des Moines, IA.

Cash / Self-Pay

$72

Average discount available for prompt cash payment at this facility.

Insurance Median

$39

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: $72 (213%)

Insurance Median: $39 (116%)

Cash: $72 (213% of Medicare)

Ins. Median: $39 (116% 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
Health Choices	$22	65%
Medical Associates	$22	65%
Iowa Total Care	$25	74%
Medicaid / KanCare	$25	74%
Aetna	$31 - $39	92%
Medicare (plans)	$31 - $33	92%
Blue Cross Blue Shield	$32	95%
UnitedHealthcare	$32 - $211	95%
1199 National Benefit Fund	$39	116%
Allied Benefit Systems	$39	116%
Asr Health Benefits	$39	116%
Christian Brother Services	$39	116%
Coventry	$39	116%
First Health	$39	116%
Lucent Health	$39	116%
Luminare Health	$39	116%
Medical Mutual	$39	116%
Meritain	$39	116%
Trustmark Small Business Benefits	$39	116%
Webtpa	$39	116%
Amish Hospital Aid	$43	127%
Centivo	$46	136%
Oscar	$46	136%
Ambetter / Centene	$54	160%
Claimdoc	$65	193%
Nova	$65	193%
Cigna	$67	199%
Health Partners	$70	208%
Auxiant	$72	213%
Medica	$72	213%
Midlands	$72	213%
Midlands Choice	$72	213%
Usa Managed Care	$94	279%
Crime Victim Assistance	$111	329%
Iowa Dept Of Public Health	$111	329%
Geha	$189	560%

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 $72.
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 Mercyone Des Moines 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.