CMS Price Transparency Data

Physical therapy (functional capacity test)

Facility: Fayette County Hospital

Billing Code: 97750 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97750
Insurance Median: $100
Cash Discount Price: $154
vs. Medicare Baseline: 2.96x Medicare

The contracted insurance negotiated median rate for a Physical therapy (functional capacity test) at Fayette County Hospital is $100. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $154. Compared to the federal Medicare reimbursement reference rate of $33.73, this hospital’s rate is 2.96x the Medicare baseline. Located in 650 W Taylor St, Vandalia, IL.

Cash / Self-Pay

$154

Average discount available for prompt cash payment at this facility.

Insurance Median

$100

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: $154 (457%)

Insurance Median: $100 (296%)

Cash: $154 (457% of Medicare)

Ins. Median: $100 (296% 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 296% of the Medicare baseline (a markup of 196%). 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
Health Alliance Mcare	$49	145%
Healthlink Mcr Adv	$49	145%
Humana	$49	145%
Aetna	$71 - $106	210%
Blue Cross Blue Shield	$71 - $129	210%
Illinicare - All Plans	$71	210%
Medicaid / KanCare	$71	210%
Meridian-All Plans	$71	210%
Coventry/Ghp-All Plans	$100	296%
Healthlink Hmo	$108	320%
Cigna	$116	344%
Healthlink Ppo - All Other Plans	$123	365%
Health Alliance - All Other Plans	$127	377%
UnitedHealthcare	$128	379%
Multiplan - All Plans	$131	388%

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 $154.
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 Fayette County 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.