CMS Price Transparency Data

Physical therapy (functional capacity test)

Facility: Mercy Hospital Southeast

Billing Code: 97750 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97750
Insurance Median: $43
Cash Discount Price: $90
vs. Medicare Baseline: 1.27x Medicare

The contracted insurance negotiated median rate for a Physical therapy (functional capacity test) at Mercy Hospital Southeast is $43. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $90. Compared to the federal Medicare reimbursement reference rate of $33.73, this hospital’s rate is 1.27x the Medicare baseline. Located in 1701 Lacey St, Cape Girardeau, MO.

Cash / Self-Pay

$90

Average discount available for prompt cash payment at this facility.

Insurance Median

$43

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: $90 (267%)

Insurance Median: $43 (127%)

Cash: $90 (267% of Medicare)

Ins. Median: $43 (127% 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
Aetna	$9 - $89	27%
Medicaid / KanCare	$9 - $53	27%
Auxiant Contracted [320462]	$30 - $60	89%
Blue Cross Blue Shield	$30 - $132	89%
Cross Timbers Hospice [20098]	$30	89%
Dept Of Veteran Affairs Contracted [320106]	$30	89%
Elara Caring Aspire Hospice Contracted [320433]	$30	89%
Elara Caring Aspire Hospice [20433]	$30	89%
Halo Hcr Inc Hospice Contracted [320432]	$30	89%
Halo Hcr Inc Hospice [20432]	$30	89%
Healthlink Contracted [320179]	$30 - $220	89%
Humana	$30 - $118	89%
Imagine 360 Contracted [320494]	$30	89%
Kindful Hospice Contracted [320434]	$30	89%
Kindful Hospice [20434]	$30	89%
Medicare (plans)	$30 - $32	89%
Mercy Benefit Admin Contracted [320251]	$30 - $95	89%
Mercy Hospice Okc [20252]	$30	89%
Pace Of The Ozarks Contracted [320518]	$30	89%
Tricare	$30	89%
Ambetter / Centene	$31	92%
American Health Advantage Of Mo Mcr Hmo Contracted [320264]	$31	92%
Home State Health Plan Contracted [320187]	$31	92%
Hope Trust Contracted [320488]	$31	92%
UnitedHealthcare	$31 - $45	92%
Provider Partners Health Plans Contracted [320450]	$35	104%
Consociate Consolidated Health Contracted [320490]	$42 - $68	125%
Centivo Contracted [320505]	$51	151%
Ebms Contracted [320493]	$51	151%
Preferred Health Plan Contracted [320522]	$54	160%
Reflect Health Contracted [320492]	$55	163%
First Health Contracted [320128]	$89	264%
Health Alliance Contracted [320164]	$90	267%
Aither Health Contracted [320449]	$95	282%
Edison Health Solutions Contracted [320502]	$95	282%
Mercy Benefit Admin [20251]	$95	282%
Yuzu Health Contracted [320521]	$95	282%
Workers Comp [20426]	$104 - $111	308%
Multiplan Contracted [320270]	$111	329%
Private Health Care Systems Contracted [320320]	$111	329%
Cigna	$286	848%

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 $90.
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 Southeast 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.