CMS Price Transparency Data

Physical therapy (functional capacity test)

Facility: St Anthony Regional Hospital & Nursing Home

Billing Code: 97750 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97750
Insurance Median: $48
Cash Discount Price: $114
vs. Medicare Baseline: 1.42x Medicare

The contracted insurance negotiated median rate for a Physical therapy (functional capacity test) at St Anthony Regional Hospital & Nursing Home is $48. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $114. Compared to the federal Medicare reimbursement reference rate of $33.73, this hospital’s rate is 1.42x the Medicare baseline. Located in 311 South Clark Street, Carroll, IA.

Cash / Self-Pay

$114

Average discount available for prompt cash payment at this facility.

Insurance Median

$48

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: $114 (338%)

Insurance Median: $48 (142%)

Cash: $114 (338% of Medicare)

Ins. Median: $48 (142% 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
Aetna	$41 - $103	122%
Humana	$41 - $97	122%
Medica Mcr - All Plans	$41	122%
UnitedHealthcare	$41 - $92	122%
Va Ccn - All Plans	$41	122%
Wellpoint Mcr Adv	$41	122%
Ia Total Care Mcr	$42	125%
Ia Total Care Mcaid	$47	139%
Wellpoint Mcaid - All Other Plans	$47	139%
Molina Mcaid - All Plans	$48	142%
Ia Total Care Comm - All Other Plans	$53	157%
Midlands Choice - All Plans	$107	317%
Wellmark Hmo	$136	403%
Wellmark Ppo-All Other Plans	$150	445%

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 $114.
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 St Anthony Regional Hospital & Nursing Home 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.