CMS Price Transparency Data

Physical therapy (functional capacity test)

Facility: Sparrow Ionia Hospital

Billing Code: 97750 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97750
Insurance Median: $169
Cash Discount Price: $46
vs. Medicare Baseline: 5.01x Medicare

The contracted insurance negotiated median rate for a Physical therapy (functional capacity test) at Sparrow Ionia Hospital is $169. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $46. Compared to the federal Medicare reimbursement reference rate of $33.73, this hospital’s rate is 5.01x the Medicare baseline. Located in 3565 S State Road, Ionia, MI.

Cash / Self-Pay

$46

Average discount available for prompt cash payment at this facility.

Insurance Median

$169

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: $46 (136%)

Insurance Median: $169 (501%)

Cash: $46 (136% of Medicare)

Ins. Median: $169 (501% 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 501% of the Medicare baseline (a markup of 401%). 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
Medicare (plans)	$32 - $73	95%
Blue Cross Blue Shield	$37 - $173	110%
Blue Care Network	$63	187%
Aetna	$69 - $207	205%
Covenant Advantage	$69	205%
Medigold	$69	205%
Senior Community Care	$69	205%
Humana	$72 - $224	213%
Priority	$169	501%
UnitedHealthcare	$212	629%
Cigna	$219	649%
Great West Healthcare	$219	649%
Asr	$221	655%
Health Alliance Plan	$221	655%
Cofinity	$224	664%
Mclaren Commercial	$246	729%

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 $46.
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 Sparrow Ionia 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.