CMS Price Transparency Data

Physical therapy (functional capacity test)

Facility: Elkhart General Hospital

Billing Code: 97750 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97750
Insurance Median: $84
Cash Discount Price: $83
vs. Medicare Baseline: 2.49x Medicare

The contracted insurance negotiated median rate for a Physical therapy (functional capacity test) at Elkhart General Hospital is $84. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $83. Compared to the federal Medicare reimbursement reference rate of $33.73, this hospital’s rate is 2.49x the Medicare baseline. Located in 600 E Blvd, Elkhart, IN.

Cash / Self-Pay

$83

Average discount available for prompt cash payment at this facility.

Insurance Median

$84

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: $83 (246%)

Insurance Median: $84 (249%)

Cash: $83 (246% of Medicare)

Ins. Median: $84 (249% 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 249% of the Medicare baseline (a markup of 149%). 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
Mclaren (Mi	$17	50%
UnitedHealthcare	$17 - $86	50%
Devoted Healthcare	$26 - $33	77%
Blue Cross Blue Shield	$27 - $60	80%
Aetna	$32 - $87	95%
Humana	$32 - $90	95%
Pace	$32	95%
Plain Church	$48 - $102	142%
Caresource	$51 - $166	151%
Mhs	$57 - $166	169%
Cha	$77 - $100	228%
Immergrun	$77 - $102	228%
Php	$83 - $90	246%
Cigna	$92 - $97	273%
Multiplan	$92	273%
Signature	$93	276%
Encore	$95	282%
Heartland	$128	379%
Mdwise	$166	492%

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 $83.
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 Elkhart General 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.