Physical therapy (functional capacity test)
Facility: Lmh
Billing Code: 97750 (CPT)
- CPT Billing Code: 97750
- Insurance Median: $36
- Cash Discount Price: $33
- vs. Medicare Baseline: 1.07x 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 |
|---|---|---|
| UnitedHealthcare | $18 - $131 | 53% |
| Blue Cross Blue Shield | $18 - $85 | 53% |
| Allwell | $29 - $32 | 86% |
| Medicare (plans) | $32 | 95% |
| Haskell Indian Health Services | $32 | 95% |
| Humana | $32 | 95% |
| Cigna | $32 - $88 | 95% |
| Ambetter / Centene | $42 - $49 | 125% |
| Aetna | $83 - $109 | 246% |
| Non Contracted | $105 | 311% |
| First Health | $122 | 362% |
Consumer Guidance & Cost Commentary
For this Physical therapy (functional capacity test) service, the facility's cash median rate of $33.00 is notably lower than the state average of $33.73 and the Medicare benchmark of $33.73. While most commercial payers negotiate rates ranging from $18 to $131, the cash price offers a distinct advantage for patients with high-deductible plans or those without insurance, as it avoids the administrative markups inherent in negotiated billing. It is important to note that while the facility is in-network for many plans, the negotiated rates for some carriers, such as Cigna and Aetna, can exceed the cash price, making direct payment a potentially more economical option if the patient's deductible has not yet been met.
Patients should proactively inquire about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront fee reductions can further lower the final cost by bypassing the costly insurance claims processing cycle. Although the facility is in-network for major carriers like UnitedHealthcare and Blue Cross Blue Shield, the wide variance in allowed amounts across different plans means that the actual out-of-pocket cost depends heavily on individual plan details. To ensure transparency, consumers are encouraged to request an itemized bill if discrepancies arise, as summary bills often obscure specific charges that could be disputed or corrected to align with the facility's published rates.