CMS Price Transparency Data

Physical therapy (functional capacity test)

Facility: Jacksonville Memorial Hospital

Billing Code: 97750 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97750
Insurance Median: $101
Cash Discount Price: $165
vs. Medicare Baseline: 2.99x Medicare

The contracted insurance negotiated median rate for a Physical therapy (functional capacity test) at Jacksonville Memorial Hospital is $101. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $165. Compared to the federal Medicare reimbursement reference rate of $33.73, this hospital’s rate is 2.99x the Medicare baseline. Located in 1600 W Walnut St, Jacksonville, IL.

Cash / Self-Pay

$165

Average discount available for prompt cash payment at this facility.

Insurance Median

$101

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: $165 (489%)

Insurance Median: $101 (299%)

Cash: $165 (489% of Medicare)

Ins. Median: $101 (299% 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 299% of the Medicare baseline (a markup of 199%). 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	$24 - $169	71%
Coventry	$25 - $32	74%
Health Alliance	$25 - $130	74%
Humana	$25 - $144	74%
Medicare (plans)	$25 - $32	74%
UnitedHealthcare	$26 - $122	77%
Tricare	$29 - $32	86%
Corvel/Corcare	$58 - $72	172%
Illinois Workers Compensation	$63 - $93	187%
Medicaid / KanCare	$71	210%
Molina Healthcare	$71	210%
Health Alliance Mh Employee Plan	$74 - $78	219%
Commercial Workers Compensation	$88	261%
Current Health Network	$89 - $127	264%
6 Degrees Health	$97 - $101	288%
Hope Trust	$97 - $101	288%
Hst	$97 - $101	288%
Cigna	$112 - $117	332%
Aetna	$113 - $152	335%
Healthlink	$137 - $144	406%
Phcs/Multiplan	$145 - $152	430%
Hfn	$153 - $161	454%
Liability	$161 - $169	477%

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 $165.
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 Jacksonville 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.