Physical therapy (functional capacity test)
Facility: Holton Community Hospital
Billing Code: 97750 (CPT)
- CPT Billing Code: 97750
- Insurance Median: $69
- Cash Discount Price: $62
- vs. Medicare Baseline: 2.05x 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 205% of the Medicare baseline (a markup of 105%). 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 |
|---|---|---|
| UnitedHealthcare | $44 - $100 | 130% |
| Aetna | $44 - $83 | 130% |
| Humana | $44 | 130% |
| Kansas Superior Select - All Plans | $45 | 133% |
| Blue Cross Blue Shield | $53 | 157% |
| Preferred Health Fn Select - All Other Plans | $69 | 205% |
| Preferred Health Freedom | $69 | 205% |
| Preferred Health Professionals | $69 | 205% |
| Wppa Providers - All Plans | $79 | 234% |
| Medicaid / KanCare | $83 | 246% |
Consumer Guidance & Cost Commentary
For the Physical therapy (functional capacity test) procedure at Holton Community Hospital in Holton, KS, the cash price of $62.00 is notably lower than the facility's negotiated rates, which range from $44 to $100 depending on the insurance plan. While the median negotiated rate across all payers is $69.00, patients with high-deductible plans may find the cash price more advantageous if their insurance allows them to pay the full negotiated amount, which exceeds the cash rate. It is important to note that the facility's cash price of $62.00 is significantly higher than the Medicare benchmark of $33.73, illustrating that commercial rates often include substantial markups beyond the federal baseline. To minimize costs, patients should verify if the hospital offers "self-pay" or "prompt-pay" discounts, which can reduce the final bill by 20% to 50% when paid upfront, bypassing the administrative overhead associated with insurance claims processing.
The data indicates that while the lowest negotiated rate for this service is $44.00 (offered by UnitedHealthcare, Aetna, and Humana), the highest rate reaches $100.00, highlighting significant variation based on network tier and contract terms. Patients should be aware that assuming an in-network status guarantees the lowest price is a common pitfall, as different insurers negotiate different ceilings for the same CPT code. Furthermore, because the No Surprises Act prohibits balance billing for out-of-network providers at in-network facilities, patients should ensure they receive an itemized bill to identify any unbundled charges or services not rendered. Before scheduling, it is advisable to request a