CMS Price Transparency Data

Physical therapy (functional capacity test)

Facility: Anderson Hospital

Billing Code: 97750 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97750
Insurance Median: $46
Cash Discount Price: $122
vs. Medicare Baseline: 1.36x Medicare

The contracted insurance negotiated median rate for a Physical therapy (functional capacity test) at Anderson Hospital is $46. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $122. Compared to the federal Medicare reimbursement reference rate of $33.73, this hospital’s rate is 1.36x the Medicare baseline. Located in 6800 State Route 162, Maryville, IL.

Cash / Self-Pay

$122

Average discount available for prompt cash payment at this facility.

Insurance Median

$46

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: $122 (362%)

Insurance Median: $46 (136%)

Cash: $122 (362% of Medicare)

Ins. Median: $46 (136% 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
Medicaid / KanCare	$22 - $45	65%
Tricare	$31 - $32	92%
Aetna	$32 - $144	95%
Clear Springs Health	$32	95%
Devoted Health Ppo	$32	95%
Essence	$32 - $33	95%
Humana	$32	95%
Medicare (plans)	$32 - $33	95%
UnitedHealthcare	$32 - $203	95%
Health Care Service Corporation	$40 - $112	119%
Ambetter / Centene	$46	136%
Blue Choice	$46	136%
Work Comp	$49 - $26,600	145%
Hopetrust	$80	237%
Healthlink	$122	362%
Self Pay	$122 - $25,000	362%
Blue Cross Blue Shield	$131 - $135	388%
Mercy Benefit Admin	$155	460%
Mercy Aco	$160	474%
Cigna	$171	507%
Multiplan/Phcs	$183	543%
Beech Street Corporation	$220	652%

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 $122.
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 Anderson 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.