Physical therapy (functional capacity test)
Facility: Rooks County Health Center
Billing Code: 97750 (CPT)
- CPT Billing Code: 97750
- Insurance Median: $101
- Cash Discount Price: $122
- vs. Medicare Baseline: 2.99x 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 299% of the Medicare baseline (a markup of 199%). 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 | $52 - $101 | 154% |
| Veterans Admin - All Plans | $52 - $101 | 154% |
| Celtic Mcr Adv | $52 - $101 | 154% |
| Blue Cross Blue Shield | $54 | 160% |
| Celtic Comm - All Other Plans | $58 - $111 | 172% |
| Aetna | $100 - $193 | 296% |
| Preferred Benefits Admin | $100 - $193 | 296% |
| UnitedHealthcare | $100 - $193 | 296% |
| Health Partners - All Plans | $106 - $204 | 314% |
| Preferred Hlthcare - All Other Plans | $106 - $204 | 314% |
| Healthy Blue Mcaid - All Plans | $112 - $214 | 332% |
Consumer Guidance & Cost Commentary
For the Physical therapy (functional capacity test) procedure at Rooks County Health Center in Plainville, KS, the facility's cash price of $122.00 is notably lower than the state average of $163.00, making it a cost-effective option for self-pay patients. While the facility's negotiated rates with major payers like Aetna, UnitedHealthcare, and Preferred Benefits Admin range from $100 to $193, these amounts often exceed the cash price, suggesting that paying out-of-pocket might result in lower out-of-pocket costs for individuals with high-deductible plans. It is important to note that the facility, a Critical Access Hospital owned by a Government Hospital District, offers a median negotiated rate of $101.00, which aligns closely with the cash price, but patients should still verify if their specific insurance plan has a lower allowed amount before scheduling.
To maximize savings, patients should proactively request "self-pay" or "prompt-pay" discounts before check-in, as these upfront payment incentives can reduce the final bill by 20% to 50% by bypassing costly insurance claims processing. If a patient receives a bill from an out-of-network provider or encounters unexpected charges, they should avoid paying immediately and instead request an itemized billing audit to identify errors or unbundled codes, as over 80% of hospital bills contain discrepancies. Additionally, since Medicare sets a benchmark rate of $33.73 for this service, the commercial negotiated rates reflect significant markups, reinforcing the value of comparing facility rates directly against the Medicare amount rather than the facility's full chargemaster list.