CMS Price Transparency Data

Physical therapy (functional capacity test)

Facility: Mercy Hospital Aurora

Billing Code: 97750 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97750
Insurance Median: $118
Cash Discount Price: $91
vs. Medicare Baseline: 3.50x Medicare

The contracted insurance negotiated median rate for a Physical therapy (functional capacity test) at Mercy Hospital Aurora is $118. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $91. Compared to the federal Medicare reimbursement reference rate of $33.73, this hospital’s rate is 3.50x the Medicare baseline. Located in 500 Porter Avenue, Aurora, MO.

Cash / Self-Pay

$91

Average discount available for prompt cash payment at this facility.

Insurance Median

$118

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: $91 (270%)

Insurance Median: $118 (350%)

Cash: $91 (270% of Medicare)

Ins. Median: $118 (350% 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 350% of the Medicare baseline (a markup of 250%). 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
Medicaid / KanCare	$18 - $71	53%
Medicare (plans)	$32 - $41	95%
Aetna	$40 - $125	119%
Blue Cross Blue Shield	$40 - $140	119%
Cherokee Nation Health Serv Contracted [320066]	$40	119%
Cigna	$40 - $119	119%
Cross Timbers Hospice [20098]	$40	119%
Elara Caring Aspire Hospice [20433]	$40	119%
Globalhealth Contracted [320145]	$40	119%
Halo Hcr Inc Hospice Contracted [320432]	$40	119%
Halo Hcr Inc Hospice [20432]	$40	119%
Humana	$40 - $119	119%
Indian Health Service Contracted [320198]	$40	119%
Kindful Hospice Contracted [320434]	$40	119%
Kindful Hospice [20434]	$40	119%
Medical Associates Health Contracted [320444]	$40	119%
Mercy Hospice Okc [20252]	$40	119%
Mercy Mgd Behavioral Health Contracted [320259]	$40	119%
Pace Of The Ozarks Contracted [320518]	$40	119%
Provider Partners Health Plans Contracted [320450]	$40	119%
Qual Choice Contracted [320325]	$40	119%
UnitedHealthcare	$40 - $133	119%
Dept Of Veteran Affairs Contracted [320106]	$41	122%
Tricare	$41	122%
Healthscope Contracted [320182]	$52	154%
Centivo Contracted [320505]	$56	166%
Administrative Payor Contracted [320005]	$63	187%
Ambetter / Centene	$71	210%
Home State Health Plan Contracted [320187]	$71	210%
Novasys Contracted [320285]	$71	210%
Healthlink Contracted [320179]	$91 - $126	270%
Preferred Health Plan Contracted [320522]	$91	270%
Health Systems Inc Contracted [320174]	$112	332%
Insurance System Inc Contracted [320465]	$112	332%
Point C Contracted [320238]	$112 - $119	332%
Point C [20238]	$112	332%
Workers Comp [20426]	$112 - $119	332%
Medica Contracted [320239]	$118	350%
90 Degree Benefits Contracted [320436]	$119	353%
Aither Health Contracted [320449]	$119	353%
American Healthcare Alliance Contracted [320020]	$119	353%
Auxiant Contracted [320462]	$119	353%
Benefit Management Contracted [320052]	$119	353%
Ebms Contracted [320493]	$119	353%
Edison Health Solutions Contracted [320502]	$119	353%
Evolutions Health Care Contracted [320124]	$119	353%
First Health Contracted [320128]	$119	353%
Imagine 360 Contracted [320494]	$119	353%
Mercy Benefit Admin Contracted [320251]	$119	353%
Reflect Health Contracted [320492]	$119	353%
Show-Me Health Administrators Contracted [320483]	$119	353%
United Medical Resources Contracted [320454]	$119 - $123	353%
Yuzu Health Contracted [320521]	$119	353%
Usa Managed Care Org Contracted [320429]	$123	365%
Multiplan Contracted [320270]	$133	394%
Private Health Care Systems Contracted [320320]	$133	394%

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 $91.
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 Aurora 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.