CMS Price Transparency Data

Physical therapy (functional capacity test)

Facility: Memorial Medical Center

Billing Code: 97750 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97750
Insurance Median: $101
Cash Discount Price: $169
vs. Medicare Baseline: 2.99x Medicare

The contracted insurance negotiated median rate for a Physical therapy (functional capacity test) at Memorial Medical Center is $101. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $169. Compared to the federal Medicare reimbursement reference rate of $33.73, this hospital’s rate is 2.99x the Medicare baseline. Located in 701 N First St, Springfield, IL.

Cash / Self-Pay

$169

Average discount available for prompt cash payment at this facility.

Insurance Median

$101

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: $169 (501%)

Insurance Median: $101 (299%)

Cash: $169 (501% of Medicare)

Ins. Median: $101 (299% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 299% of the Medicare baseline (a markup of 199%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Veterans Administration	$23	68%
Blue Cross Blue Shield	$29 - $169	86%
Aetna	$31 - $128	92%
Health Alliance	$31 - $110	92%
Medicare (plans)	$31 - $169	92%
Tricare	$31	92%
UnitedHealthcare	$31 - $105	92%
Humana	$33 - $101	98%
Medicaid / KanCare	$45	133%
Molina	$46	136%
Current Health Network Ppo	$76	225%
Commercial Workers Compensation	$79	234%
Illinois Workers Compensation	$83	246%
Healthlink	$84 - $106	249%
Cigna	$89	264%
Phcs/Multiplan	$91 - $101	270%
6 Degrees Health	$101	299%
Hopetrust	$101	299%
Hst	$101	299%
Magellan	$101	299%
Consociate	$110	326%
Hfn	$110	326%
Preferred Plan	$127	377%
Soi Mcfarland	$127	377%
Soi Rushville	$127	377%
Corvel	$135	400%
Methodist First Choice	$135	400%
Mutual Medical Plans	$144	427%
Liability	$169	501%

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 $169.
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 Memorial 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.