CMS Price Transparency Data
Physical therapy (functional capacity test)
Facility: Mercy Hospital Springfield
Billing Code: 97750 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 97750
- Insurance Median: $101
- Cash Discount Price: $115
- vs. Medicare Baseline: 2.99x Medicare
The contracted insurance negotiated median rate for a Physical therapy (functional capacity test) at Mercy Hospital Springfield is $101. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $115. Compared to the federal Medicare reimbursement reference rate of $33.73, this hospital’s rate is 2.99x the Medicare baseline. Located in 2115 S. Fremont Ave, Springfield, MO.
Cash / Self-Pay
$115
Average discount available for prompt cash payment at this facility.
Insurance Median
$101
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: $115 (341%)
Insurance Median: $101 (299%)
Cash: $115 (341% of Medicare)
Ins. Median: $101 (299% 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 299% of the Medicare baseline (a markup of 199%). 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.
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 - $268 | 53% |
| Medicaid / KanCare | $18 - $78 | 53% |
| Aetna | $30 - $96 | 89% |
| Centivo Contracted [320505] | $30 | 89% |
| Centurion Of Missouri [20459] | $30 | 89% |
| Champva [20065] | $30 | 89% |
| Cherokee Nation Health Serv Contracted [320066] | $30 | 89% |
| Cigna | $30 - $148 | 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% |
| Humana | $30 - $131 | 89% |
| Indian Health Service Contracted [320198] | $30 | 89% |
| Indian Health Service [20198] | $30 | 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% |
| Mercy Rehab Hospital Contracted [320260] | $30 | 89% |
| Pace Of The Ozarks Contracted [320518] | $30 | 89% |
| Qual Choice Contracted [320325] | $30 | 89% |
| Tricare | $30 | 89% |
| UnitedHealthcare | $30 - $1,293 | 89% |
| Provider Partners Health Plans Contracted [320450] | $33 | 98% |
| Healthscope Contracted [320182] | $38 | 113% |
| Providrs Care Network Contracted [320484] | $60 | 178% |
| Medica Contracted [320239] | $68 - $76 | 202% |
| Medica [20239] | $68 - $76 | 202% |
| Benefit Management Contracted [320052] | $69 - $77 | 205% |
| Health Systems Inc Contracted [320174] | $69 - $77 | 205% |
| Insurance System Inc Contracted [320465] | $69 - $77 | 205% |
| Ambetter / Centene | $70 - $78 | 208% |
| Home State Health Plan Contracted [320187] | $70 - $78 | 208% |
| Novasys Contracted [320285] | $70 - $78 | 208% |
| Administrative Payor Contracted [320005] | $78 - $96 | 231% |
| Evolutions Health Care Contracted [320124] | $78 - $86 | 231% |
| Point C Contracted [320238] | $78 - $144 | 231% |
| Point C [20238] | $78 - $86 | 231% |
| Medical Destinations Contracted [320242] | $86 - $96 | 255% |
| Mercy Benefit Admin Contracted [320251] | $86 - $195 | 255% |
| Workers Comp [20426] | $86 - $163 | 255% |
| United Medical Resources Contracted [320454] | $90 - $837 | 267% |
| First Health Contracted [320128] | $97 - $108 | 288% |
| Aither Health Contracted [320449] | $99 - $109 | 294% |
| Auxiant Contracted [320462] | $99 - $125 | 294% |
| Ebms Contracted [320493] | $99 - $109 | 294% |
| Edison Health Solutions Contracted [320502] | $99 - $109 | 294% |
| Healthlink Contracted [320179] | $99 - $154 | 294% |
| Imagine 360 Contracted [320494] | $99 - $109 | 294% |
| Reflect Health Contracted [320492] | $99 - $109 | 294% |
| Yuzu Health Contracted [320521] | $99 - $109 | 294% |
| 90 Degree Benefits Contracted [320436] | $104 - $195 | 308% |
| Federal Medical Center Contracted [320127] | $104 - $115 | 308% |
| Show-Me Health Administrators Contracted [320483] | $104 - $195 | 308% |
| Multiplan Contracted [320270] | $133 - $148 | 394% |
| Private Health Care Systems Contracted [320320] | $133 - $148 | 394% |
| Compcare Of The Ozarks Contracted [320437] | $137 - $152 | 406% |
| American Healthcare Alliance Contracted [320020] | $138 - $154 | 409% |
| Qual Choice Contracted [320324] | $138 - $154 | 409% |
| Municipal Health Plan Contracted [320271] | $140 - $156 | 415% |
| Usa Managed Care Org Contracted [320429] | $152 - $169 | 451% |
| Ppo Plus Contracted [320310] | $156 - $173 | 462% |