CMS Price Transparency Data

Physical therapy (functional capacity test)

Facility: St Francis Hospital

Billing Code: 97750 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97750
Insurance Median: $78
Cash Discount Price: $70
vs. Medicare Baseline: 2.31x Medicare

The contracted insurance negotiated median rate for a Physical therapy (functional capacity test) at St Francis Hospital is $78. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $70. Compared to the federal Medicare reimbursement reference rate of $33.73, this hospital’s rate is 2.31x the Medicare baseline. Located in 1215 Franciscan Dr, Litchfield, IL.

Cash / Self-Pay

$70

Average discount available for prompt cash payment at this facility.

Insurance Median

$78

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: $70 (208%)

Insurance Median: $78 (231%)

Cash: $70 (208% of Medicare)

Ins. Median: $78 (231% 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 231% of the Medicare baseline (a markup of 131%). 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
Clear Spring Health of Illinois	$20	59%
Blue Cross Blue Shield	$20 - $22	59%
Humana	$20	59%
Molina Healthcare	$21 - $47	62%
UnitedHealthcare	$21 - $97	62%
Aetna	$21 - $68	62%
Amish Community	$27	80%
Wexford	$45	133%
Meridian Health Plan	$49	145%
Celtic Insurance Company	$49	145%
Claim Doc	$51	151%
Hopetrust	$56	166%
Wellfirst	$62	184%
First Health	$72	213%
Caterpillar, Inc.	$78	231%
Current Health Solutions	$81	240%
Multiplan/Phcs	$82	243%
Consociate Group	$82	243%
Healthlink	$83	246%
Provider Network of America	$87	258%
Healthcare Finest Network (Hfn)	$87	258%
Live360	$97	288%
Healthscope	$97	288%
Illinois Breast and Cervical Cancer Program	$97	288%
Health Alliance Medical Plans	$97	288%
Cigna	$97	288%
Interplan	$97	288%
Naphcare	$97	288%

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 $70.
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 Francis Hospital 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.