Physical therapy (functional capacity test)
Facility: Mcpherson Hospital
Billing Code: 97750 (CPT)
- CPT Billing Code: 97750
- Insurance Median: $105
- Cash Discount Price: $101
- vs. Medicare Baseline: 3.11x 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 311% of the Medicare baseline (a markup of 211%). 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 |
|---|---|---|
| Tricare | $28 | 83% |
| Va Ccn - All Plans | $32 | 95% |
| UnitedHealthcare | $32 - $137 | 95% |
| Wellcare Mcr Adv - All Plans | $32 | 95% |
| Humana | $32 | 95% |
| Healthy Blue Mcr Adv | $32 | 95% |
| Blue Cross Blue Shield | $32 | 95% |
| Ambetter / Centene | $37 | 110% |
| Wppa - All Plans | $96 | 285% |
| Medical Associates - All Plans | $103 | 305% |
| Central Plains - All Plans | $103 | 305% |
| Christian Health Aid - All Plans | $110 | 326% |
| Aetna | $113 - $137 | 335% |
| Multiplan - All Plans | $123 | 365% |
| First Health - All Plans | $130 | 385% |
| Health Partners - All Plans | $130 | 385% |
| Cigna | $130 | 385% |
| Medicaid / KanCare | $137 | 406% |
| Health Blue Mcaid - All Other Plans | $140 | 415% |
Consumer Guidance & Cost Commentary
For the CPT code 97750, representing a physical therapy functional capacity test, McPherson Hospital in Kansas charges a gross list price of $137.00. While the facility offers a cash median price of $101.00, which is lower than the state average of $111.00, patients with high-deductible plans may find that paying out-of-pocket is more cost-effective than using insurance. Many commercial payers, including UnitedHealthcare and Aetna, have negotiated rates that range from $32 to $137, often exceeding the cash price due to administrative costs and contract structures. It is important to note that while the No Surprises Act protects patients from balance billing for emergency care and non-emergency services from out-of-network providers at in-network facilities, patients should still verify their specific plan details to avoid unexpected charges.
To ensure you receive the most accurate pricing, we recommend requesting an itemized billing audit before finalizing payment, as over 80% of hospital bills contain errors such as unbundled codes or services not rendered. Additionally, patients should inquire about prompt-pay discounts, which can reduce the total cost by 20% to 50% if paid in full upfront, bypassing the costly insurance claims cycle. When comparing rates, it is essential to look at the Medicare benchmark of $33.73 rather than the hospital's gross chargemaster; commercial negotiated rates typically average between 200% and 300% of this federal rate, whereas fair pricing is generally defined as 120% to 150%. By checking for self-pay or prompt-pay options and