CMS Price Transparency Data

Physical therapy (functional capacity test)

Facility: Hamilton Memorial Hospital

Billing Code: 97750 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97750
Insurance Median: $52
Cash Discount Price: $57
vs. Medicare Baseline: 1.54x Medicare

The contracted insurance negotiated median rate for a Physical therapy (functional capacity test) at Hamilton Memorial Hospital is $52. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $57. Compared to the federal Medicare reimbursement reference rate of $33.73, this hospital’s rate is 1.54x the Medicare baseline. Located in 611 S Marshall Avenue, McLeansboro, IL.

Cash / Self-Pay

$57

Average discount available for prompt cash payment at this facility.

Insurance Median

$52

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: $57 (169%)

Insurance Median: $52 (154%)

Cash: $57 (169% of Medicare)

Ins. Median: $52 (154% 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	$25 - $27	74%
Blue Cross Blue Shield	$26 - $61	77%
Aetna	$27 - $60	80%
Health Alliance	$27 - $54	80%
Humana	$27	80%
Medicare (plans)	$27 - $32	80%
UnitedHealthcare	$27 - $48	80%
Wellcare	$27 - $32	80%
Alliance Coal	$47	139%
Healthscope	$47	139%
Wellfirst (Ssmhic)	$47	139%
Hope Trust	$50	148%
Cigna	$53	157%
Hfn, Inc	$54 - $60	160%
Healthlink	$57 - $60	169%
Multiplan	$57	169%
Siho	$60	178%
Three Rivers Provider	$60	178%
Healthsmart	$64	190%
Stratose	$64	190%

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 $57.
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 Hamilton Memorial 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.