CMS Price Transparency Data

Physical therapy (functional capacity test)

Facility: Rush Memorial Hospital

Billing Code: 97750 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97750
Insurance Median: $109
Cash Discount Price: $122
vs. Medicare Baseline: 3.23x Medicare

The contracted insurance negotiated median rate for a Physical therapy (functional capacity test) at Rush Memorial Hospital is $109. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $122. Compared to the federal Medicare reimbursement reference rate of $33.73, this hospital’s rate is 3.23x the Medicare baseline. Located in 1300 N Main St, Rushville, IN.

Cash / Self-Pay

$122

Average discount available for prompt cash payment at this facility.

Insurance Median

$109

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: $122 (362%)

Insurance Median: $109 (323%)

Cash: $122 (362% of Medicare)

Ins. Median: $109 (323% 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 323% of the Medicare baseline (a markup of 223%). 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 Net	$27 - $104	80%
Aetna	$28 - $325	83%
Caresource Mcr Adv	$28 - $110	83%
Humana	$28 - $325	83%
My True Advantage - All Plans	$28 - $110	83%
UnitedHealthcare	$28 - $283	83%
Blue Cross Blue Shield	$29 - $259	86%
Today'S Option Mcr Adv-All Plans	$29 - $113	86%
Viant Beech St Mcr Adv	$29 - $113	86%
Caresource Marketplace-All Other Plans	$45 - $175	133%
Cigna	$73 - $283	216%
Phcs-All Plans	$73 - $283	216%
Consumers Life Ins-All Plans	$82 - $318	243%
Coventry/First Health-All Plans	$82 - $318	243%
Sagamore-All Plans	$83 - $325	246%
Siho-All Plans	$83 - $325	246%
Multiplan-All Plans	$84 - $329	249%
Community Health Alliance-All Plans	$85 - $333	252%
Encore Health Services-All Plans	$89 - $347	264%

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 $122.
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 Rush 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.