CMS Price Transparency Data

Physical therapy (functional capacity test)

Facility: Monroe County Hospital

Billing Code: 97750 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97750
Insurance Median: $56
Cash Discount Price: $66
vs. Medicare Baseline: 1.66x Medicare

The contracted insurance negotiated median rate for a Physical therapy (functional capacity test) at Monroe County Hospital is $56. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $66. Compared to the federal Medicare reimbursement reference rate of $33.73, this hospital’s rate is 1.66x the Medicare baseline. Located in 6580 165Th Street, Albia, IA.

Cash / Self-Pay

$66

Average discount available for prompt cash payment at this facility.

Insurance Median

$56

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: $66 (196%)

Insurance Median: $56 (166%)

Cash: $66 (196% of Medicare)

Ins. Median: $56 (166% 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
Mahp Mcare - All Plans	$46	136%
Tricare	$46	136%
UnitedHealthcare	$46 - $104	136%
Va Ccn - All Plans	$46	136%
Aetna	$47 - $103	139%
Amerigroup Mcare	$47	139%
Humana	$47	139%
Wellmark Mcare	$47	139%
Iowa Total Care Mcaid - All Plans	$55	163%
Molina Mcaid - All Plans	$56	166%
Amerigroup Mcaid - All Other Plans	$57	169%
Centivo - All Plans	$69	205%
Midlands Choice - All Plans	$77	228%
Preferred Hlth - All Plans	$82	243%
Geha - All Plans	$88	261%
Multiplan - All Plans	$99	294%
Integrated Hp - All Plans	$107	317%
Wellmark Hmo	$200	593%
Wellmark Ppo - All Other Plans	$216	640%

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 $66.
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 Monroe County 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.