Physical therapy (functional capacity test)
Facility: Clara Barton Hospital
Billing Code: 97750 (CPT)
- CPT Billing Code: 97750
- Insurance Median: $79
- Cash Discount Price: $62
- vs. Medicare Baseline: 2.34x 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 234% of the Medicare baseline (a markup of 134%). 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 | $53 | 157% |
| 6 Degrees Health - All Plans | $62 | 184% |
| Wppa-All Plans | $70 | 208% |
| Phcs - All Plans | $79 | 234% |
| UnitedHealthcare | $79 | 234% |
| Aetna | $79 | 234% |
| Hlth Partners Of Ks-All Plans | $81 | 240% |
Consumer Guidance & Cost Commentary
For this Physical therapy (functional capacity test) at Clara Barton Hospital in Hoisington, KS, the negotiated rates for major payers like Blue Cross Blue Shield and 6 Degrees Health are $53, which is lower than the facility's cash median of $62. However, the median negotiated rate across all seven payers is $79, significantly higher than the cash price. This discrepancy highlights a common billing dynamic where insurance contracts often exceed cash rates due to administrative costs and claim processing fees; patients with high-deductible plans may find paying the $62 cash price directly more cost-effective than relying on insurance to cover the $79 negotiated amount.
The facility's gross charge of $88 serves as the baseline, but the actual cost to patients varies based on payment method and insurance status. While the Medicare benchmark of $33.73 provides a clear cost baseline, commercial rates here average 2.3 times the Medicare amount, reflecting standard market pricing for this service. To minimize costs, patients should verify their specific plan's allowed amount before scheduling and inquire directly with the hospital about "self-pay" or "prompt-pay" discounts, which can reduce the final bill if paid in full upfront.