CMS Price Transparency Data

Physical therapy (functional capacity test)

Facility: St Alexius Medical Center

Billing Code: 97750 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97750
Insurance Median: $36
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.07x Medicare

The contracted insurance negotiated median rate for a Physical therapy (functional capacity test) at St Alexius Medical Center is $36. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $33.73, this hospital’s rate is 1.07x the Medicare baseline. Located in 1555 N Barrington Rd, Hoffman Estates, IL.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$36

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%)

Insurance Median: $36 (107%)

Ins. Median: $36 (107% 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
Aarp	$32	95%
UnitedHealthcare	$32 - $35	95%
Aetna	$34 - $93	101%
Blue Cross Blue Shield	$34 - $93	101%
Cigna	$34 - $106	101%
Covid-19 Uninsured	$34	101%
Humana	$34	101%
Medicare (plans)	$34 - $35	101%
Molina Healthcare Of Illinois	$35	104%
Bright Health	$43	127%
Smarthealth	$48	142%
Actin Care	$53	157%
Ambetter / Centene	$55	163%
County Care	$93	276%
Harmony Health Plan	$93	276%
Illinicare	$93	276%
Medicaid / KanCare	$93	276%
Meridian	$93	276%

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 $X.
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 Alexius 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.