Physical therapy (functional capacity test)
Facility: Saint John Hospital
Billing Code: 97750 (CPT)
- CPT Billing Code: 97750
- Insurance Median: $32
- Cash Discount Price: $31
- vs. Medicare Baseline: 0.95x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Healthy Blue | $18 - $33 | 53% |
| UnitedHealthcare | $18 - $45 | 53% |
| Medicaid / KanCare | $18 | 53% |
| Celtic | $18 - $86 | 53% |
| Blue Cross Blue Shield | $25 - $54 | 74% |
| Midland Care Connection | $32 | 95% |
| Cigna | $32 | 95% |
| Medicare (plans) | $32 | 95% |
| Kansas Superior Select | $32 | 95% |
| Aetna | $32 | 95% |
| Tricare | $32 | 95% |
| Corizon | $45 | 133% |
| Employer Direct Healthcare | $45 | 133% |
| Well Path | $45 | 133% |
| Centurion | $48 | 142% |
| Naphcare | $49 | 145% |
Consumer Guidance & Cost Commentary
For this Physical therapy (functional capacity test) service at Saint John Hospital in Leavenworth, KS, the cash price of $31.00 is notably lower than the facility's Medicare benchmark of $33.73. While the hospital's negotiated rates with major payers like Healthy Blue, UnitedHealthcare, and Celtic range from $18 to $86, these amounts often exceed the cash price, meaning patients with high-deductible plans might save money by paying out-of-pocket. It is important to note that while the No Surprises Act protects patients from balance billing for out-of-network providers at in-network facilities, patients should still verify their specific plan details before scheduling. If you choose to pay cash, ask the hospital about "self-pay" or "prompt-pay" discounts, which can further reduce the final amount owed.
The facility's cash rate of $31.00 is also lower than the median negotiated rate of $32.00, suggesting that paying directly may be more cost-effective than relying on insurance for this specific procedure. However, if your insurance plan has a low deductible or high out-of-pocket maximum, the negotiated rate could result in a lower total cost than paying cash. To ensure you are not overcharged, request a full itemized bill that lists every CPT code and unit cost, as summary bills often hide unbundled charges or services not rendered. Always dispute any unexpected balance bills in writing, citing the No Surprises Act if applicable, and avoid signing consent waivers that waive your rights to review out-of-network costs for emergency or mandatory ancillary services.