Physical therapy (functional capacity test)
Facility: Lane County Hospital
Billing Code: 97750 (CPT)
- CPT Billing Code: 97750
- Insurance Median: $58
- Cash Discount Price: $58
- vs. Medicare Baseline: 1.72x 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 |
|---|---|---|
| Aetna | $52 - $55 | 154% |
| UnitedHealthcare | $52 - $58 | 154% |
| Healthy Blue Mcaid | $58 | 172% |
| Medicaid / KanCare | $58 - $64 | 172% |
| Healthy Blue Mcr Adv - All Other Plans | $58 | 172% |
| Wppa Providers-All Plans | $87 | 258% |
Consumer Guidance & Cost Commentary
For the CPT code 97750, representing a physical therapy functional capacity test, the cash price at Lane County Hospital in Dighton, KS, is $58.00. This cash rate aligns exactly with the facility's median negotiated rate and the median amount paid by insurers, suggesting that for patients with high-deductible plans, paying cash upfront may be the most cost-effective option. While the facility is a Critical Access Hospital owned by a Government Hospital District, the data does not provide specific county or state average comparisons for this service, so patients should verify local pricing norms directly with the hospital or their insurance carrier.
The Medicare benchmark for this procedure is $33.73, which serves as a baseline for evaluating the facility's pricing structure. The cash price of $58.00 represents a 1.7x markup relative to the Medicare rate, which falls within the typical range where commercial rates exceed Medicare benchmarks. Patients should be aware that while the No Surprises Act protects against balance billing for out-of-network providers at in-network facilities, it does not apply to cash-pay scenarios. To ensure you receive the best possible rate, it is advisable to explicitly request a "self-pay" or "prompt-pay" discount before scheduling your visit, as these upfront incentives can significantly reduce the final amount owed.