CMS Price Transparency Data

Physical therapy (functional capacity test)

Facility: Pinckneyville Community Hospital

Billing Code: 97750 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97750
Insurance Median: $90
Cash Discount Price: $109
vs. Medicare Baseline: 2.67x Medicare

The contracted insurance negotiated median rate for a Physical therapy (functional capacity test) at Pinckneyville Community Hospital is $90. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $109. Compared to the federal Medicare reimbursement reference rate of $33.73, this hospital’s rate is 2.67x the Medicare baseline. Located in 5383 State Route 154, Pinckneyville, IL.

Cash / Self-Pay

$109

Average discount available for prompt cash payment at this facility.

Insurance Median

$90

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: $109 (323%)

Insurance Median: $90 (267%)

Cash: $109 (323% of Medicare)

Ins. Median: $90 (267% 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 267% of the Medicare baseline (a markup of 167%). 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
Humana	$40	119%
Umwa Mcr Adv - All Plans	$40	119%
UnitedHealthcare	$40 - $89	119%
Wellcare Mcr Adv - All Plans	$40	119%
Aetna	$41 - $197	122%
Blue Cross Blue Shield	$78 - $197	231%
Healthlink Hmo	$86	255%
Phcs - All Other Plans	$89	264%
Cigna	$90	267%
Healthlink Ppo - All Other Plans	$90	267%
Healthlink Work Comp	$90	267%
Phcs Savility	$93	276%
Multiplan - All Plans	$98	291%
Ambetter / Centene	$197	584%
Medicaid / KanCare	$197	584%

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 $109.
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 Pinckneyville Community 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.