CMS Price Transparency Data

Physical therapy (functional capacity test)

Facility: Essentia Health St Mary's Medical Center

Billing Code: 97750 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97750
Insurance Median: $59
Cash Discount Price: $78
vs. Medicare Baseline: 1.75x Medicare

The contracted insurance negotiated median rate for a Physical therapy (functional capacity test) at Essentia Health St Mary's Medical Center is $59. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $78. Compared to the federal Medicare reimbursement reference rate of $33.73, this hospital’s rate is 1.75x the Medicare baseline. Located in 402 East Second Street, Duluth, MN.

Cash / Self-Pay

$78

Average discount available for prompt cash payment at this facility.

Insurance Median

$59

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: $78 (231%)

Insurance Median: $59 (175%)

Cash: $78 (231% of Medicare)

Ins. Median: $59 (175% 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
Itasca Med Care	$33	98%
Advocare/Security Health	$34	101%
Blue Cross Blue Shield	$34 - $90	101%
Freedom Blue Ppo	$34	101%
Healthpartners Care Msho / Mcr Adv	$34	101%
Imcare Msho (Ref Req)	$34	101%
Imcare Msho Pcc Prime	$34	101%
Imcare Msho Ref Req	$34	101%
Medica Advantage Solutions	$34	101%
Medica Msho/Dual Solutions	$34	101%
Medica Prime Solution Group	$34	101%
Medicare (plans)	$34	101%
Nd Va Administration	$34	101%
Platinum Blue / Vantage Blue	$34	101%
Primewest	$34	101%
Primewest Msho	$34	101%
Secure Blue Msho	$34	101%
Ubh Cost Plan	$34	101%
Ubh Msho	$34	101%
Ucare Msho	$34	101%
UnitedHealthcare	$34 - $86	101%
Medica Access	$39	116%
Healthpartners Care Pmap	$47	139%
Sanford Health Plan	$51 - $70	151%
Blue Plus Pmap Pcc Prime	$52 - $59	154%
Medica	$65 - $67	193%
Medica Uplan	$65	193%
Healthpartners	$71 - $84	210%
Medica Choice	$72	213%
Ucare	$78	231%
Cigna	$84	249%
Healthpartners Pcc Prime	$84	249%
Wea	$85 - $91	252%
America'S Ppo	$91	270%
Security Health	$91	270%
Wps	$98 - $99	291%
Aetna	$100	296%
Healthscope Benefits	$100	296%
Healtheos	$101	299%

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 $78.
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 Essentia Health St Mary's Medical Center 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.