CMS Price Transparency Data

Physical therapy (functional capacity test)

Facility: Methodist Hospitals Inc

Billing Code: 97750 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97750
Insurance Median: $111
Cash Discount Price: $108
vs. Medicare Baseline: 3.29x Medicare

The contracted insurance negotiated median rate for a Physical therapy (functional capacity test) at Methodist Hospitals Inc is $111. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $108. Compared to the federal Medicare reimbursement reference rate of $33.73, this hospital’s rate is 3.29x the Medicare baseline. Located in 600 Grant St, Gary, IN.

Cash / Self-Pay

$108

Average discount available for prompt cash payment at this facility.

Insurance Median

$111

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: $108 (320%)

Insurance Median: $111 (329%)

Cash: $108 (320% of Medicare)

Ins. Median: $111 (329% 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 329% of the Medicare baseline (a markup of 229%). 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
Aetna	$32 - $114	95%
Blue Cross Blue Shield	$32 - $186	95%
Humana	$32 - $186	95%
Medicare (plans)	$32	95%
United Heathcare	$32	95%
Zing	$33	98%
Caresource Maketplace	$53	157%
Cigna	$59 - $64	175%
Ambetter / Centene	$64	190%
UnitedHealthcare	$64 - $313	190%
Physicians Health Plan Of Northern Indiana	$89	264%
Encore	$92 - $137	273%
Phcs	$105	311%
Siho	$108	320%
Sagamore	$111	329%
Multiplan	$112	332%
Hfn	$120 - $131	356%
Magnacare	$153	454%
Caresource	$186	551%
Managed Health Services	$186	551%
Medicaid / KanCare	$186	551%

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 $108.
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 Methodist Hospitals Inc 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.