CMS Price Transparency Data
Physical therapy (functional capacity test)
Facility: Mercy Hospital St Louis
Billing Code: 97750 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 97750
- Insurance Median: $65
- Cash Discount Price: $81
- vs. Medicare Baseline: 1.93x Medicare
The contracted insurance negotiated median rate for a Physical therapy (functional capacity test) at Mercy Hospital St Louis is $65. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $81. Compared to the federal Medicare reimbursement reference rate of $33.73, this hospital’s rate is 1.93x the Medicare baseline. Located in 615 New Ballas Road, Saint Louis, MO.
Cash / Self-Pay
$81
Average discount available for prompt cash payment at this facility.
Insurance Median
$65
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: $81 (240%)
Insurance Median: $65 (193%)
Cash: $81 (240% of Medicare)
Ins. Median: $65 (193% 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.
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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 |
|---|---|---|
| Aetna | $5 - $184 | 15% |
| Medicaid / KanCare | $5 - $145 | 15% |
| American Health Advantage Of Mo Mcr [10473] | $32 | 95% |
| Blue Cross Blue Shield | $32 - $274 | 95% |
| Cherokee Nation Health Serv Contracted [320066] | $32 | 95% |
| Cigna | $32 - $233 | 95% |
| Cross Timbers Hospice [20098] | $32 | 95% |
| Dept Of Veteran Affairs Contracted [320106] | $32 | 95% |
| Elara Caring Aspire Hospice Contracted [320433] | $32 | 95% |
| Elara Caring Aspire Hospice [20433] | $32 | 95% |
| Globalhealth Contracted [320145] | $32 | 95% |
| Halo Hcr Inc Hospice Contracted [320432] | $32 | 95% |
| Halo Hcr Inc Hospice [20432] | $32 | 95% |
| Humana | $32 | 95% |
| Kindful Hospice Contracted [320434] | $32 | 95% |
| Kindful Hospice [20434] | $32 | 95% |
| Medicare (plans) | $32 - $151 | 95% |
| Mercy Hospice Okc [20252] | $32 | 95% |
| Pace Of The Ozarks Contracted [320518] | $32 | 95% |
| Qual Choice Contracted [320325] | $32 | 95% |
| Tricare | $32 | 95% |
| UnitedHealthcare | $32 - $193 | 95% |
| Medica Contracted [320239] | $33 - $137 | 98% |
| Ambetter / Centene | $34 - $145 | 101% |
| Home State Health Plan Contracted [320187] | $34 - $145 | 101% |
| Novasys Contracted [320285] | $34 - $145 | 101% |
| Provider Partners Health Plans Contracted [320450] | $35 | 104% |
| Healthscope Contracted [320182] | $40 | 119% |
| Health Choices Contracted [320448] | $49 - $91 | 145% |
| Health Choices [20448] | $49 - $91 | 145% |
| Medical Associates Health Contracted [320444] | $49 - $91 | 145% |
| Federal Medical Center Contracted [320127] | $53 - $98 | 157% |
| Insurance System Inc Contracted [320465] | $53 - $98 | 157% |
| Point C Contracted [320238] | $53 - $98 | 157% |
| Tri State Healthcare Coalition Contracted [320379] | $53 - $98 | 157% |
| Aither Health Contracted [320449] | $54 - $215 | 160% |
| Aither Health [20449] | $54 - $215 | 160% |
| Auxiant Contracted [320462] | $54 - $215 | 160% |
| Centivo Contracted [320505] | $54 | 160% |
| Ebms Contracted [320493] | $54 - $215 | 160% |
| Edison Health Solutions Contracted [320502] | $54 - $215 | 160% |
| Healthlink Contracted [320179] | $54 - $225 | 160% |
| Imagine 360 Contracted [320494] | $54 - $215 | 160% |
| Mercy Benefit Admin Contracted [320251] | $54 - $215 | 160% |
| Mercy Benefit Admin [20251] | $54 - $215 | 160% |
| Reflect Health Contracted [320492] | $54 - $215 | 160% |
| Show-Me Health Administrators Contracted [320483] | $54 - $219 | 160% |
| Yuzu Health Contracted [320521] | $54 - $215 | 160% |
| First Health Contracted [320128] | $57 - $107 | 169% |
| Mercy Mgd Behavioral Health Contracted [320259] | $57 - $106 | 169% |
| Multiplan Contracted [320270] | $57 - $113 | 169% |
| Preferred Health Plan Contracted [320522] | $57 | 169% |
| Private Health Care Systems Contracted [320320] | $57 - $106 | 169% |
| Workers Comp [20426] | $62 - $121 | 184% |
| Hope Trust Contracted [320488] | $73 | 216% |
| United Medical Resources Contracted [320454] | $107 - $193 | 317% |