CMS Price Transparency Data

Physical therapy (functional capacity test)

Facility: Merit Health Madison

Billing Code: 97750 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97750
Insurance Median: $59
Cash Discount Price: $31
vs. Medicare Baseline: 1.75x Medicare

The contracted insurance negotiated median rate for a Physical therapy (functional capacity test) at Merit Health Madison is $59. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $31. Compared to the federal Medicare reimbursement reference rate of $33.73, this hospital’s rate is 1.75x the Medicare baseline. Located in 161 River Oaks Drive, Canton, MS.

Cash / Self-Pay

$31

Average discount available for prompt cash payment at this facility.

Insurance Median

$59

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: $31 (92%)

Insurance Median: $59 (175%)

Cash: $31 (92% of Medicare)

Ins. Median: $59 (175% 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
Ms-Can-Molina	$28	83%
Ms-Can-Magnolia	$29	86%
Ms-Can-Truecare	$29	86%
Medicare (plans)	$31	92%
Humana	$32	95%
Wellcare	$32	95%
Devoted_Health	$33	98%
Advhealth	$34	101%
Blue Cross Blue Shield	$41	122%
Mpcn	$59	175%
Molina-Chip	$60	178%
Firstchoice	$62	184%
Magnolia-Chip	$62	184%
Truecare-Chip	$62	184%
Molina_Exchange	$67	199%
Ambetter / Centene	$78	231%
Cigna	$78	231%
United	$78	231%
United_Exchange	$78	231%

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 $31.
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 Merit Health Madison 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.