CMS Price Transparency Data

Physical therapy (functional capacity test)

Facility: Warner Hospital and Health Services

Billing Code: 97750 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97750
Insurance Median: $155
Cash Discount Price: $192
vs. Medicare Baseline: 4.60x Medicare

The contracted insurance negotiated median rate for a Physical therapy (functional capacity test) at Warner Hospital and Health Services is $155. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $192. Compared to the federal Medicare reimbursement reference rate of $33.73, this hospital’s rate is 4.60x the Medicare baseline. Located in 422 W White St, Clinton, IL.

Cash / Self-Pay

$192

Average discount available for prompt cash payment at this facility.

Insurance Median

$155

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: $192 (569%)

Insurance Median: $155 (460%)

Cash: $192 (569% of Medicare)

Ins. Median: $155 (460% 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 460% of the Medicare baseline (a markup of 360%). 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
Blue Cross Blue Shield	$65 - $403	193%
Aetna	$68 - $349	202%
Health Alliance Med Adv	$68 - $169	202%
Humana	$68 - $349	202%
Molina Mcr/Mcd Dual	$68 - $169	202%
UnitedHealthcare	$68 - $349	202%
Wellcare Mcr Adv-All Plans	$68 - $169	202%
Healthlink Hmo	$128 - $321	379%
City Of Clinton (Employees Serv)-All Plans	$132 - $329	391%
Cigna	$137 - $341	406%
Harmony Hp Mcaid-All Plans	$137	406%
Medicaid / KanCare	$137	406%
Meridian Hp-All Plans	$137	406%
Molina-All Other Plans	$137	406%
Caterpillar-All Plans	$140 - $349	415%
Multiplan Phcs-All Plans	$140 - $349	415%
Health Alliance-All Other Plans	$145 - $362	430%
Healthlink Ppo/Work Comp-All Other Plans	$145 - $362	430%
Consociate Care Ppo-All Plans	$148 - $370	439%
Hfn Ppo/Epo-All Plans	$148 - $370	439%
Three Rivers-All Plans	$156 - $390	462%

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 $192.
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 Warner Hospital and Health Services 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.