CMS Price Transparency Data

Physical therapy (functional capacity test)

Facility: Wilcox Memorial Hospital

Billing Code: 97750 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97750
Insurance Median: $46
Cash Discount Price: $87
vs. Medicare Baseline: 1.36x Medicare

The contracted insurance negotiated median rate for a Physical therapy (functional capacity test) at Wilcox Memorial Hospital is $46. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $87. Compared to the federal Medicare reimbursement reference rate of $33.73, this hospital’s rate is 1.36x the Medicare baseline. Located in 3-3420 Kuhio Highway, Lihue, HI.

Cash / Self-Pay

$87

Average discount available for prompt cash payment at this facility.

Insurance Median

$46

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: $87 (258%)

Insurance Median: $46 (136%)

Cash: $87 (258% of Medicare)

Ins. Median: $46 (136% 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
UnitedHealthcare	$20 - $36	59%
Alohacare	$38 - $46	113%
Ohana	$39 - $58	116%
Hmsa	$46	136%
Mdx	$46 - $116	136%
Devoted	$48	142%
Uha	$52	154%
Pac Admin	$76 - $130	225%
Hwmg/Hmaa	$113	335%
Hcha	$116	344%
Kaiser	$116	344%
Multiplan	$116 - $123	344%
Verdegard	$116	344%

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 $87.
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 Wilcox Memorial 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.