CMS Price Transparency Data

Physical therapy (functional capacity test)

Facility: Dallas County Hospital

Billing Code: 97750 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97750
Insurance Median: $50
Cash Discount Price: $56
vs. Medicare Baseline: 1.48x Medicare

The contracted insurance negotiated median rate for a Physical therapy (functional capacity test) at Dallas County Hospital is $50. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $56. Compared to the federal Medicare reimbursement reference rate of $33.73, this hospital’s rate is 1.48x the Medicare baseline. Located in 610 Tenth Street, Perry, IA.

Cash / Self-Pay

$56

Average discount available for prompt cash payment at this facility.

Insurance Median

$50

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: $56 (166%)

Insurance Median: $50 (148%)

Cash: $56 (166% of Medicare)

Ins. Median: $50 (148% 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
Aetna	$27 - $51	80%
Humana	$27 - $51	80%
Medicare (plans)	$27 - $51	80%
UnitedHealthcare	$27 - $96	80%
Amerigroup Wellpoint	$30 - $58	89%
Iowa Total Care Mcd Adv (Active 7/1/19)	$30 - $58	89%
Medicaid / KanCare	$30 - $58	89%
Molina Healthcare Of Iowa Mcd Rep	$30 - $58	89%

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 $56.
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 Dallas County 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.