Physical therapy (functional capacity test)
Facility: Ellsworth County Medical Center
Billing Code: 97750 (CPT)
- CPT Billing Code: 97750
- Insurance Median: $53
- Cash Discount Price: $56
- vs. Medicare Baseline: 1.57x 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.
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 |
|---|---|---|
| Humana | $26 - $53 | 77% |
| Healthy Blue Mcr Adv | $26 | 77% |
| Va Ccn-All Plans | $26 | 77% |
| Triwest -All Plans | $26 | 77% |
| UnitedHealthcare | $36 - $56 | 107% |
| Aetna | $50 | 148% |
| First Health - All Plans | $50 | 148% |
| Blue Cross Blue Shield | $50 - $53 | 148% |
| Cigna | $53 | 157% |
| Coventry Mcaid-All Plans | $56 | 166% |
| Healthy Blue Mcaid- All Other Plans | $56 | 166% |
| Medicaid / KanCare | $56 | 166% |
| Providers Care-Wppa-All Plans | $84 | 249% |
Consumer Guidance & Cost Commentary
For the Physical therapy (functional capacity test) service at Ellsworth County Medical Center, the cash price is $56.00, which matches the facility's negotiated rate for UnitedHealthcare and several other payers. This cash price is significantly higher than the state average for this procedure, which is approximately $43.00 based on the median paid data. While commercial insurance plans like Humana and Healthy Blue Mcr Adv negotiate rates as low as $26.00, these amounts are subject to your specific plan's deductible and copay requirements. If your insurance deductible has not yet been met, you may end up paying more out-of-pocket than if you paid the cash price directly, making the $56.00 cash rate a potentially more affordable option for those with high-deductible plans.
To ensure you are receiving the most accurate pricing, it is important to request an itemized bill rather than accepting a summary invoice, as hospitals often use broad categories to obscure individual charges. Additionally, you should verify if the facility offers a prompt-pay discount, which could reduce the $56.00 cash price by 20% to 50% if paid in full upfront. Since the facility is a Critical Access Hospital in Kansas, you should also confirm whether any ancillary services, such as lab work or imaging, are out-of-network to avoid unexpected balance billing, even though the No Surprises Act protects you from such charges for emergency care and non-emergency services at in-network facilities.