CMS Price Transparency Data

Physical therapy (functional capacity test)

Facility: Pulaski Memorial Hospital

Billing Code: 97750 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97750
Insurance Median: $148
Cash Discount Price: $164
vs. Medicare Baseline: 4.39x Medicare

The contracted insurance negotiated median rate for a Physical therapy (functional capacity test) at Pulaski Memorial Hospital is $148. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $164. Compared to the federal Medicare reimbursement reference rate of $33.73, this hospital’s rate is 4.39x the Medicare baseline. Located in 616 E 13Th St, Winamac, IN.

Cash / Self-Pay

$164

Average discount available for prompt cash payment at this facility.

Insurance Median

$148

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: $164 (486%)

Insurance Median: $148 (439%)

Cash: $164 (486% of Medicare)

Ins. Median: $148 (439% 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 439% of the Medicare baseline (a markup of 339%). 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
Ambetter / Centene	$73	216%
Blue Cross Blue Shield	$73 - $234	216%
Caresource Mcaid Hip	$73	216%
Caresource Mcare Hmo	$73	216%
Cenpatico Mcaid Hip	$73	216%
Humana	$73 - $189	216%
Mdwise Mcaid Hip - All Other Plans	$73	216%
Mhs Mcaid Hip	$73	216%
Mhs Mcare Allwell	$73	216%
UnitedHealthcare	$73 - $234	216%
Aetna	$84	249%
Caresource Exch Hmo Hix - All Other Plans	$91	270%
Sagamore Rose Acre	$175	519%
Sagamore - All Other Plans	$177	525%
Encore Ppo - All Other Plans	$199	590%
Community Health Alliance - All Plans	$209	620%
Encore Workers Comp	$211	626%
Multiplan - All Plans	$211	626%
Cigna	$223	661%
Caresource Mcaid Hhw	$234	694%
Cenpatico Mcaid Hhw - All Other Plans	$234	694%
Mdwise Mcaid Hcc	$234	694%
Mdwise Mcaid Hhw	$234	694%
Mhs Mcaid Hhw/Hcc	$234	694%

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 $164.
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 Pulaski 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.