CMS Price Transparency Data

Physical therapy (functional capacity test)

Facility: Monroe Hospital

Billing Code: 97750 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97750
Insurance Median: $49
Cash Discount Price: $32
vs. Medicare Baseline: 1.45x Medicare

The contracted insurance negotiated median rate for a Physical therapy (functional capacity test) at Monroe Hospital is $49. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $32. Compared to the federal Medicare reimbursement reference rate of $33.73, this hospital’s rate is 1.45x the Medicare baseline. Located in 4011 S Monroe Medical Park Blvd, Bloomington, IN.

Cash / Self-Pay

$32

Average discount available for prompt cash payment at this facility.

Insurance Median

$49

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: $32 (95%)

Insurance Median: $49 (145%)

Cash: $32 (95% of Medicare)

Ins. Median: $49 (145% 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
Aetna	$32	95%
Blue Cross Blue Shield	$32 - $60	95%
Care Source	$32 - $60	95%
Medicare (plans)	$32	95%
Tricare	$32	95%
UnitedHealthcare	$32 - $60	95%
Usa Senior Care Network	$32	95%
Worthington Christian Fellowship	$32	95%
Monroe Medical Group And Managed Health Services	$33 - $60	98%
Provider Partners Health Plan	$35	104%
Employer Direct Healthcare	$45	133%
Americas Choice Provider Network Acpn	$49 - $60	145%
Corvel Workers Compensation	$49 - $56	145%
Encore Health Network Workers Compensation	$49 - $60	145%
Medicaid / KanCare	$49 - $60	145%
Multiplan	$49 - $60	145%
Prime Health Services	$49 - $60	145%
Provider Network Of America	$49 - $60	145%
Provider Select	$49 - $60	145%
Three Rivers	$49 - $60	145%
Workers Compensation	$49 - $60	145%
Zelis Healthcare Fka Stratose	$49 - $60	145%

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 $32.
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 Monroe 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.