CMS Price Transparency Data

Physical therapy (functional capacity test)

Facility: Salem Memorial District Hospital

Billing Code: 97750 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 97750
  • Insurance Median: $65
  • Cash Discount Price: $76
  • vs. Medicare Baseline: 1.93x Medicare
The contracted insurance negotiated median rate for a Physical therapy (functional capacity test) at Salem Memorial District Hospital is $65. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $76. Compared to the federal Medicare reimbursement reference rate of $33.73, this hospital’s rate is 1.93x the Medicare baseline. Located in Po Box 774, Salem, MO.
Cash / Self-Pay
$76

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: $76 (225%)
Insurance Median: $65 (193%)
Cash: $76 (225% 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.

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 $15 - $123 44%
Ambetter / Centene $15 - $46 44%
Blue Cross Blue Shield $15 - $120 44%
Humana $15 - $116 44%
Tricare $15 - $46 44%
Triwest $15 - $46 44%
UnitedHealthcare $15 - $104 44%
Veteran'S Affairs $15 - $46 44%
Healthlink $29 - $89 86%
First Health $35 - $109 104%
Mercy - C.B. Management Company/Joplin Supply Company $35 - $109 104%
Mercy - City Of Springfield $35 - $109 104%
Mercy - Clayco $35 - $109 104%
Mercy - Commerce Bank $35 - $109 104%
Mercy - Diversified Plastics $35 - $109 104%
Mercy - Employers Benefit Alliance $35 - $109 104%
Mercy - Evolutions $35 - $109 104%
Mercy - Fabick Cat $35 - $109 104%
Mercy - Firsthealth Network $35 - $109 104%
Mercy - Health Management Network $35 - $109 104%
Mercy - Health Systems Inc $35 - $109 104%
Mercy - Liberty Utilities/Empire District Electric $35 - $109 104%
Mercy - Life Church $35 - $109 104%
Mercy - Missouri State University $35 - $109 104%
Mercy - Prime Health Services $35 - $109 104%
Mercy - Quiktrip Corporation $35 - $109 104%
Mercy - Shinesolar $35 - $109 104%
Mercy - Springfield Public Schools $35 - $109 104%
Mercy - Springfield Remanufacturing $35 - $109 104%
Mercy - Sumnerone $35 - $109 104%
Mercy - Trailiner $35 - $109 104%
Mercy - Walmart Mercy Accountable Care Plan $35 - $109 104%
Mercy-American Healthcare Alliance $35 - $109 104%
Phcs $35 - $116 104%
Cigna $37 - $116 110%
Mercy - Compresults $40 - $123 119%
Mercy - Corvel Corporation $40 - $123 119%
Mercy - Novasys $40 - $123 119%
Mercy - Scurlock Industries $40 - $123 119%
Mercy - Usa Managed Care Organization $40 - $123 119%
Right Choice-Alliance $88 261%
Right Choice-Regular $100 296%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: Po Box 774, Salem, MO 65560
  • CMS Rating: ★★★★☆
  • Ownership Type: Government - Hospital District or Authority
  • Hospital Type: Critical Access Hospitals