Physical therapy (functional capacity test)
Facility: Rawlins County Health Center
Billing Code: 97750 (CPT)
- CPT Billing Code: 97750
- Insurance Median: $92
- Cash Discount Price: $90
- vs. Medicare Baseline: 2.73x 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 273% of the Medicare baseline (a markup of 173%). 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 | $54 | 160% |
| UnitedHealthcare | $92 | 273% |
Consumer Guidance & Cost Commentary
For the CPT code 97750, representing a physical therapy functional capacity test, the Rawlins County Health Center lists a cash median price of $90.00, which is notably lower than the facility's negotiated rates of $92.00 and the maximum allowed amounts of $54.00 to $92.00 for Blue Cross Blue Shield and UnitedHealthcare, respectively. While Medicare sets a benchmark of $33.73, commercial insurance contracts often result in higher out-of-pocket costs for patients who have not yet met their deductibles. Because the cash price is lower than the negotiated rates, patients with high-deductible plans or those who have already met their out-of-pocket maximums may find paying directly out-of-pocket to be the most cost-effective option. It is important to verify this with the hospital before scheduling, as they may offer additional "self-pay" or "prompt-pay" discounts that further reduce the final amount owed.
Patients should be aware that insurance companies negotiate specific rates for in-network providers, which can sometimes exceed the cash price due to administrative overhead and contract structures. If you choose to use insurance, ensure you understand your plan's deductible status and allowed amount, as the facility is not bound by the full chargemaster gross price of $106.00. To avoid unexpected costs, always request a detailed, itemized bill before paying, as summary bills can obscure individual charges and potential errors. If you receive a balance bill for services rendered at an in-network facility, you may be entitled to protections under the No Surprises Act, which bans balance billing for emergency and non-emergency care from out-of-network providers at in-network