Physical therapy (functional capacity test)
Facility: Pratt Regional Medical Center
Billing Code: 97750 (CPT)
- CPT Billing Code: 97750
- Insurance Median: $77
- Cash Discount Price: $63
- vs. Medicare Baseline: 2.28x 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 228% of the Medicare baseline (a markup of 128%). 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 |
|---|---|---|
| Celtic Insurance Company | $32 | 95% |
| Healthy Blue | $33 | 98% |
| UnitedHealthcare | $35 - $97 | 104% |
| Christian Health Aid | $64 - $71 | 190% |
| Health Partners Of Kansas | $72 - $81 | 213% |
| Aetna | $77 - $86 | 228% |
| Choicecare | $85 - $95 | 252% |
Consumer Guidance & Cost Commentary
For this Physical therapy (functional capacity test) at Pratt Regional Medical Center in Pratt, KS, the cash price is $63.00, which is lower than the facility's negotiated rates ranging from $32.00 to $97.00 across seven payers. While the cash rate is competitive, patients should verify their specific insurance coverage, as some plans may negotiate higher amounts than the cash price. For instance, UnitedHealthcare's negotiated range spans $35.00 to $97.00, meaning members with high deductibles might find the $63.00 cash option more cost-effective if their insurance allowed amount exceeds this figure. It is crucial to confirm your plan's deductible status and allowed amounts before scheduling to avoid unexpected out-of-pocket costs.
The facility's cash rate of $63.00 is notably lower than the Medicare benchmark of $33.73, indicating a markup relative to the federal government's cost-based reimbursement. However, the data shows a median negotiated rate of $77.00, which is higher than the cash price, suggesting that paying out-of-pocket could save money compared to standard insurance billing for this service. Patients should proactively ask the hospital about self-pay or prompt-pay discounts, which can further reduce the final bill by bypassing administrative fees and claims processing costs. Always request an itemized bill before paying to ensure no errors or unbundled charges are included, as over 80% of hospital bills contain discrepancies that can be resolved through a formal audit.