Physical therapy (functional capacity test)
Facility: Susan B Allen Memorial Hospital
Billing Code: 97750 (CPT)
- CPT Billing Code: 97750
- Insurance Median: $554
- Cash Discount Price: $57
- vs. Medicare Baseline: 16.42x 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.
Elevated Commercial Rate Alert (Value-Gap)
The negotiated rate at this facility is 1642% of the Medicare baseline (a markup of 1542%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
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 |
|---|---|---|
| UnitedHealthcare | $350 | 1038% |
| Providrs Care | $757 | 2244% |
Consumer Guidance & Cost Commentary
For this Physical therapy (functional capacity test) at Susan B Allen Memorial Hospital in El Dorado, KS, the cash price is $57.00, which is significantly lower than the facility's negotiated rates of $554.00 and the state average of $57.00. While insurance plans like UnitedHealthcare and Providrs Care have negotiated rates of $350 and $757 respectively, patients with high-deductible plans may find the cash price more affordable if their insurance allowed amount exceeds the cash rate. It is important to note that commercial negotiated rates often include administrative overhead and can be substantially higher than the actual cost of care, making the cash option a potential savings strategy for those who do not require insurance coverage for this service.
Patients should verify if the hospital offers "self-pay" or "prompt-pay" discounts before scheduling, as paying upfront can sometimes reduce the final balance further. Additionally, if you are using insurance, be aware of the No Surprises Act protections which prevent balance billing for out-of-network providers at in-network facilities, though unexpected ancillary charges from out-of-network services like emergency physicians or labs could still occur. To ensure you are not overcharged, always request a full itemized bill before paying, as summary invoices often hide unbundled codes or services not rendered. Since over 80% of hospital bills contain errors, disputing any discrepancies in writing with the billing supervisor is the most effective way to reduce medical debt.