CMS Price Transparency Data

Physical therapy (functional capacity test)

Facility: Mercy Hospital Joplin

Billing Code: 97750 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97750
Insurance Median: $112
Cash Discount Price: $145
vs. Medicare Baseline: 3.32x Medicare

The contracted insurance negotiated median rate for a Physical therapy (functional capacity test) at Mercy Hospital Joplin is $112. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $145. Compared to the federal Medicare reimbursement reference rate of $33.73, this hospital’s rate is 3.32x the Medicare baseline. Located in 100 Mercy Way, Joplin, MO.

Cash / Self-Pay

$145

Average discount available for prompt cash payment at this facility.

Insurance Median

$112

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: $145 (430%)

Insurance Median: $112 (332%)

Cash: $145 (430% of Medicare)

Ins. Median: $112 (332% 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 332% of the Medicare baseline (a markup of 232%). 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
Blue Cross Blue Shield	$18 - $197	53%
Medicaid / KanCare	$18 - $62	53%
Workers Comp [20426]	$25 - $190	74%
Humana	$29 - $67	86%
Aetna	$30 - $138	89%
Centivo Contracted [320505]	$30	89%
Champva [20065]	$30	89%
Cherokee Nation Health Serv Contracted [320066]	$30	89%
Cigna	$30 - $172	89%
Cross Timbers Hospice [20098]	$30	89%
Dept Of Veteran Affairs Contracted [320106]	$30	89%
Elara Caring Aspire Hospice [20433]	$30	89%
Globalhealth Contracted [320145]	$30	89%
Halo Hcr Inc Hospice Contracted [320432]	$30	89%
Halo Hcr Inc Hospice [20432]	$30	89%
Indian Health Service Contracted [320198]	$30 - $145	89%
Kindful Hospice Contracted [320434]	$30	89%
Kindful Hospice [20434]	$30	89%
Medicare (plans)	$30 - $33	89%
Mercy Hospice Okc [20252]	$30	89%
Mercy Mgd Behavioral Health Contracted [320259]	$30	89%
Pace Of The Ozarks Contracted [320518]	$30	89%
Provider Partners Health Plans Contracted [320450]	$30	89%
Qual Choice Contracted [320325]	$30	89%
Tricare	$30	89%
UnitedHealthcare	$30 - $91	89%
Healthscope Contracted [320182]	$38	113%
Health Choice Contracted [320166]	$48	142%
Providrs Care Network Contracted [320484]	$60	178%
Ambetter / Centene	$62	184%
Home State Health Plan Contracted [320187]	$62	184%
Novasys Contracted [320285]	$62	184%
United Medical Resources Contracted [320454]	$75 - $91	222%
Point C Contracted [320238]	$78 - $178	231%
Medica Contracted [320239]	$81	240%
Benefit Management Contracted [320052]	$96	285%
Health Systems Inc Contracted [320174]	$96	285%
Insurance System Inc Contracted [320465]	$96	285%
Administrative Payor Contracted [320005]	$100	296%
Mercy Benefit Admin Contracted [320251]	$112 - $195	332%
Aither Health Contracted [320449]	$127	377%
Auxiant Contracted [320462]	$127 - $145	377%
Ebms Contracted [320493]	$127	377%
Edison Health Solutions Contracted [320502]	$127	377%
Healthlink Contracted [320179]	$127 - $178	377%
Imagine 360 Contracted [320494]	$127	377%
Reflect Health Contracted [320492]	$127	377%
Yuzu Health Contracted [320521]	$127	377%
90 Degree Benefits Contracted [320436]	$134 - $195	397%
Show-Me Health Administrators Contracted [320483]	$134 - $195	397%
Preferred Health Plan Contracted [320522]	$145	430%
First Health Contracted [320128]	$152	451%
American Healthcare Alliance Contracted [320020]	$156	462%
Multiplan Contracted [320270]	$172	510%
Private Health Care Systems Contracted [320320]	$172	510%
Usable Contracted [320409]	$172	510%
Point C [20238]	$178	528%
Usa Managed Care Org Contracted [320429]	$196	581%
Ppo Plus Contracted [320310]	$201	596%

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 $145.
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 Mercy Hospital Joplin 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.