CMS Price Transparency Data

Physical therapy (functional capacity test)

Facility: St Marys Hospital Superior

Billing Code: 97750 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97750
Insurance Median: $47
Cash Discount Price: $86
vs. Medicare Baseline: 1.39x Medicare

The contracted insurance negotiated median rate for a Physical therapy (functional capacity test) at St Marys Hospital Superior is $47. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $86. Compared to the federal Medicare reimbursement reference rate of $33.73, this hospital’s rate is 1.39x the Medicare baseline. Located in 3500 Tower Ave, Superior, WI.

Cash / Self-Pay

$86

Average discount available for prompt cash payment at this facility.

Insurance Median

$47

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: $86 (255%)

Insurance Median: $47 (139%)

Cash: $86 (255% of Medicare)

Ins. Median: $47 (139% 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
Itasca Med Care	$33	98%
Primewest	$34	101%
Advocare/Security Health	$37	110%
Blue Cross Blue Shield	$37 - $94	110%
Freedom Blue Ppo	$37	110%
Healthpartners Care Msho / Mcr Adv	$37	110%
Imcare Msho Pcc Prime	$37	110%
Imcare Msho Ref Req	$37	110%
Medica Advantage Solutions	$37	110%
Medica Msho/Dual Solutions	$37	110%
Medica Prime Solution Group	$37	110%
Medica Uplan	$37	110%
Medicare (plans)	$37	110%
Nd Va Administration	$37	110%
Platinum Blue/Vantage Blue	$37	110%
Primewest Msho	$37	110%
Secure Blue Msho	$37	110%
Ubh Cost Plan	$37	110%
Ubh Msho	$37	110%
Ucare Msho	$37	110%
UnitedHealthcare	$37 - $106	110%
Blue Plus Pmap Pcc Prime	$45	133%
Healthpartners Care Pmap	$47	139%
Medica Access	$47	139%
Sanford Healthplan	$50	148%
Ucare	$77	228%
Healthpartners	$79 - $91	234%
Medica	$82 - $91	243%
Wea	$84 - $90	249%
Security Health	$90	267%
America'S Ppo	$91	270%
Cigna	$91	270%
Healthpartners Pcc Prime	$91	270%
Medica Choice	$94	279%
Wps	$98	291%
Aetna	$99	294%
Healtheos	$101	299%

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 $86.
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 St Marys Hospital Superior 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.