Physical therapy (functional capacity test)
Facility: Ashland Health Center
Billing Code: 97750 (CPT)
- CPT Billing Code: 97750
- Insurance Median: $75
- Cash Discount Price: $60
- vs. Medicare Baseline: 2.22x 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 222% of the Medicare baseline (a markup of 122%). 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 |
|---|---|---|
| Blue Cross Blue Shield | $25 | 74% |
| Compalliance-All Plans | $60 | 178% |
| Health Partners Of Kansas-All Plans | $64 | 190% |
| Multiplan-All Plans | $74 | 219% |
| Health Choice-All Plans | $75 | 222% |
| Medicaid / KanCare | $75 | 222% |
| Medicare (plans) | $75 | 222% |
| Medica Mcare - All Plans | $75 | 222% |
| Healthy Blue Mcr Adv - All Other Plans | $75 | 222% |
| Aetna | $75 | 222% |
| UnitedHealthcare | $75 | 222% |
| Providers Care (Wppa)-All Plans | $112 | 332% |
Consumer Guidance & Cost Commentary
For the CPT code 97750, representing a physical therapy functional capacity test at Ashland Health Center in Ashland, KS, the facility's negotiated rates are consistently $75.00 across all 12 payers, including Medicare, Medicaid, and major commercial insurers like UnitedHealthcare and Aetna. This uniform negotiated rate of $75.00 is significantly higher than the facility's cash median of $60.00, illustrating a common scenario where commercial insurance contracts exceed the cash price. While commercial rates often include administrative overhead and contractual ceilings, patients with high-deductible plans may find the cash price more advantageous if their insurance allowed amount exceeds the cash rate. It is important to note that the facility's cash price of $60.00 is lower than the Medicare benchmark of $33.73, which serves as the federal cost baseline for this service; however, commercial payers have negotiated rates that are 2.2 times the Medicare amount, reflecting standard market dynamics where in-network rates average 200% to 300% of the Medicare rate.
Patients should be aware that while the facility is a Critical Access Hospital with a voluntary non-profit ownership structure, the lack of variation in payer rates suggests a standardized contract rather than individualized negotiation. To potentially reduce costs, patients are encouraged to inquire directly with the billing department about "self-pay" or "prompt-pay" discounts, which can range from 20% to 50% off the billed amount for upfront payment. Since the facility's billing systems may default to submitting claims to insurance even for self-pay patients, signing a waiver of insurance submission at registration can prevent automatic claims