Physical therapy (functional capacity test)
Facility: Hamilton County Hospital
Billing Code: 97750 (CPT)
- CPT Billing Code: 97750
- Insurance Median: $143
- Cash Discount Price: $159
- vs. Medicare Baseline: 4.24x 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 424% of the Medicare baseline (a markup of 324%). 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 - $54 | 74% |
| First Health Coventry - All Plans | $135 | 400% |
| UnitedHealthcare | $151 | 448% |
| Cigna | $151 | 448% |
| Va Ccn - All Plans | $159 | 471% |
| Aetna | $270 | 800% |
Consumer Guidance & Cost Commentary
For this physical therapy functional capacity test at Hamilton County Hospital in Syracuse, KS, the cash price is $159, which matches the facility's negotiated rate for most major payers like UnitedHealthcare and Cigna. While the facility is a Critical Access Hospital with government ownership, the cash price is significantly higher than the state average for this service, which is $151. Patients with high-deductible plans may find paying the full cash price of $159 more cost-effective than using insurance, as the negotiated rate of $151 could still require them to pay a large portion of that amount out-of-pocket before their deductible is met.
To minimize costs, patients should explicitly ask the billing department about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront payment incentives can reduce the final bill by 20% to 50%. It is also important to request a detailed, itemized bill rather than a summary invoice, as over 80% of hospital bills contain errors such as double-billing or unbundled codes that can be disputed. Finally, while the facility's rates are well above the Medicare benchmark of $33.73, commercial rates often include administrative overhead that inflates the baseline price; therefore, comparing the cash price directly to the Medicare amount provides a clearer picture of the true cost of care than comparing it to the hospital's inflated chargemaster list.