CMS Price Transparency Data
Physical therapy (functional capacity test)
Facility: Mercy Health Saint Mary's
Billing Code: 97750 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 97750
- Insurance Median: $99
- Cash Discount Price: $88
- vs. Medicare Baseline: 2.94x Medicare
The contracted insurance negotiated median rate for a Physical therapy (functional capacity test) at Mercy Health Saint Mary's is $99. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $88. Compared to the federal Medicare reimbursement reference rate of $33.73, this hospital’s rate is 2.94x the Medicare baseline. Located in 200 Jefferson Avenue Se, Grand Rapids, MI.
Cash / Self-Pay
$88
Average discount available for prompt cash payment at this facility.
Insurance Median
$99
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: $88 (261%)
Insurance Median: $99 (294%)
Cash: $88 (261% of Medicare)
Ins. Median: $99 (294% 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 294% of the Medicare baseline (a markup of 194%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
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Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Access Health | $23 | 68% |
| Aetna | $32 - $85 | 95% |
| Align Senior Care | $32 | 95% |
| Blue Care Network Advantage | $32 | 95% |
| Blue Cross Blue Shield | $32 - $65 | 95% |
| Correctional Recovery | $32 | 95% |
| Hospice Faith | $32 | 95% |
| Hospice Of Holland | $32 | 95% |
| Medicare (plans) | $32 | 95% |
| UnitedHealthcare | $33 - $135 | 98% |
| Longevity Ipa Of Michigan Llc Health Plan Isnp | $36 | 107% |
| Oscar | $41 | 122% |
| Molina Marketplace | $42 | 125% |
| Vitalcore | $50 | 148% |
| Wellpath | $50 | 148% |
| U Of M Health Plan | $51 - $103 | 151% |
| Bcn Domestic | $65 | 193% |
| Blue Benefit Administrators Of Massachusetts | $65 | 193% |
| Blue Care Network | $65 | 193% |
| Blue Distinction Transplant | $65 | 193% |
| Blue Shield - Ca | $65 | 193% |
| Blue Shield - Id (Regence) | $65 | 193% |
| Blue Shield - Ny Highmark Northeastern | $65 | 193% |
| Blue Shield - Ny Highmark Western | $65 | 193% |
| Blue Shield - Pa (Highmark) | $65 | 193% |
| Blue Shield - Wa (Regence) | $65 | 193% |
| Health Choices | $65 - $103 | 193% |
| Kaiser Domestic | $65 | 193% |
| Priority Health | $73 - $75 | 216% |
| Wc Accident Fund | $74 | 219% |
| Wc Advantage | $74 | 219% |
| Wc Aig | $74 | 219% |
| Wc Allied | $74 | 219% |
| Wc Amerisure | $74 | 219% |
| Wc Amtrust | $74 | 219% |
| Wc Asu Risk Mgt | $74 | 219% |
| Wc Berkley Admin | $74 | 219% |
| Wc Broadspire | $74 | 219% |
| Wc Bunch & Associates | $74 | 219% |
| Wc Ccmsi | $74 | 219% |
| Wc Emc Insurance Company | $74 | 219% |
| Wc Esis | $74 | 219% |
| Wc Fcci | $74 | 219% |
| Wc Federated | $74 | 219% |
| Wc Gallagher Bassett | $74 | 219% |
| Wc Genex Care For Ohio | $74 | 219% |
| Wc Guard Insurance Company | $74 | 219% |
| Wc Hartford | $74 | 219% |
| Wc Liberty Mutual | $74 | 219% |
| Wc Meijers | $74 | 219% |
| Wc Michigan | $74 | 219% |
| Wc Mitchell Frankenmuth | $74 | 219% |
| Wc Pma | $74 | 219% |
| Wc Sedgwick | $74 | 219% |
| Wc Sentry | $74 | 219% |
| Wc Travelers | $74 | 219% |
| Wc Tristar | $74 | 219% |
| Wc Walmart | $74 | 219% |
| Wc Zurich | $74 | 219% |
| Nomi Health | $76 | 225% |
| Acs Benefit Services | $78 | 231% |
| Allied Benefit Systems | $78 | 231% |
| Claimchoice Adminstrators | $78 | 231% |
| Consociate | $78 | 231% |
| Cypress Benefit Administrators | $78 | 231% |
| Forest County Potawatomi | $78 | 231% |
| Health Smart | $78 | 231% |
| Healthgram | $78 | 231% |
| Healthscope | $78 | 231% |
| Secureone Preferred United Plans | $78 | 231% |
| Sisco Benefits | $78 | 231% |
| The Health Plan | $78 | 231% |
| Trustmark Small Business Benefits | $78 | 231% |
| Unified Group Services | $78 | 231% |
| Webtpa | $78 | 231% |
| Geha | $85 - $103 | 252% |
| Medical Mutual | $85 | 252% |
| Meritain | $85 | 252% |
| Preferred One | $85 | 252% |
| Asr Health Benefits | $86 | 255% |
| Hap | $86 - $105 | 255% |
| Caresource | $88 | 261% |
| Varipro | $88 | 261% |
| Cigna | $98 | 291% |
| 1199 National Benefit Fund | $99 | 294% |
| Allied National Global Care | $99 | 294% |
| Asrm - Reliance Standard Life Insurance | $99 | 294% |
| Christian Care Ministry | $99 | 294% |
| Dean Health | $99 | 294% |
| Fallon Health | $99 | 294% |
| Family Life Insurance Company | $99 | 294% |
| Ghc Scw | $99 | 294% |
| Group Pension Administrators | $99 | 294% |
| International Benefit Administrators | $99 | 294% |
| Lifetime Benefit Solutions | $99 | 294% |
| Manhattan Life | $99 | 294% |
| Medi Share | $99 | 294% |
| Multiplan | $99 | 294% |
| Mvp | $99 | 294% |
| Pai | $99 | 294% |
| Pan-American Life | $99 | 294% |
| Paramount Hmo | $99 | 294% |
| Phcs | $99 | 294% |
| Trinity Health Share | $99 | 294% |
| Acclaim | $103 | 305% |
| Administrative Concepts | $103 | 305% |
| Allegeant | $103 | 305% |
| Ameriben | $103 | 305% |
| American Family | $103 | 305% |
| American Healthcare Alliance | $103 | 305% |
| American Republic | $103 | 305% |
| Amerihealth | $103 | 305% |
| Aultcare | $103 | 305% |
| Automated Benefit Services | $103 | 305% |
| Auxiant | $103 | 305% |
| Benefit Administrative Systems,Llc | $103 | 305% |
| Boon Chapman | $103 | 305% |
| Cam Administrative Services | $103 | 305% |
| Christian Brother Services | $103 | 305% |
| Christian Brothers Holy Cross | $103 | 305% |
| Comprehensive Benefits | $103 | 305% |
| Continental Life Insurance | $103 | 305% |
| Custom Benefit Administrators | $103 | 305% |
| Employee Benefit Concepts | $103 | 305% |
| Employee Benefit Management | $103 | 305% |
| Enterprise Group Planning | $103 | 305% |
| Freedom Life Insurance Company | $103 | 305% |
| Group Administrators | $103 | 305% |
| Group Marketing Services | $103 | 305% |
| Guardian | $103 | 305% |
| Health America | $103 | 305% |
| Healthez | $103 | 305% |
| Humana | $103 - $135 | 305% |
| Insight | $103 | 305% |
| Intercare | $103 | 305% |
| Jfp Benefit Management | $103 | 305% |
| Jp Farley Corporation | $103 | 305% |
| Key Benefit Administrator | $103 | 305% |
| Liberty Union Life Assurance Co | $103 | 305% |
| Lucent Health | $103 | 305% |
| Luminare Health | $103 | 305% |
| Luminare Health (Detroit) | $103 | 305% |
| Medben | $103 | 305% |
| Medcost | $103 | 305% |
| Mutual Health Services | $103 | 305% |
| Mutual Of Omaha | $103 | 305% |
| Ncas | $103 | 305% |
| Nippon Life Ins | $103 | 305% |
| Nova | $103 | 305% |
| Painters Union Insurance Fund | $103 | 305% |
| Physicians Mutual | $103 | 305% |
| Plumbers Local 98 Insurance Fund | $103 | 305% |
| Prairie States | $103 | 305% |
| Primary Physician Care | $103 | 305% |
| Professional Benefit Administrators | $103 | 305% |
| The Loomis Company | $103 | 305% |
| Unicare | $103 | 305% |
| Us Health And Life | $103 | 305% |
| Valenz | $103 | 305% |
| Western & Southern Financial Group | $103 | 305% |
| Wps | $103 | 305% |
| Coventry | $107 | 317% |
| First Health | $107 | 317% |
| Cmh Allegan County | $135 | 400% |
| Cmh Ausable Valley | $135 | 400% |
| Cmh Barry County | $135 | 400% |
| Cmh Berrien County | $135 | 400% |
| Cmh Cass County | $135 | 400% |
| Cmh Clinton-Eaton-Ingham County | $135 | 400% |
| Cmh Kalamazoo | $135 | 400% |
| Cmh Kent County | $135 | 400% |
| Cmh Lenawee County | $135 | 400% |
| Cmh Misc | $135 | 400% |
| Cmh Monroe County | $135 | 400% |
| Cmh Montcalm County | $135 | 400% |
| Cmh Muskegon County | $135 | 400% |
| Cmh Newaygo County | $135 | 400% |
| Cmh North Country | $135 | 400% |
| Cmh Northern Lakes County | $135 | 400% |
| Cmh Ottawa County | $135 | 400% |
| Cmh Van Buren County | $135 | 400% |
| Cmh West Mi County | $135 | 400% |
| Magellan Behavioral Health | $135 | 400% |