Physical therapy (functional capacity test)
Facility: Medicine Lodge Memorial Hospital
Billing Code: 97750 (CPT)
- CPT Billing Code: 97750
- Insurance Median: $74
- Cash Discount Price: $83
- vs. Medicare Baseline: 2.19x 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 219% of the Medicare baseline (a markup of 119%). 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 | $56 - $77 | 166% |
| Humana | $64 - $88 | 190% |
| Aetna | $65 - $96 | 193% |
| Hpk-All Plans | $66 - $91 | 196% |
| UnitedHealthcare | $66 - $91 | 196% |
| Medicaid / KanCare | $70 - $96 | 208% |
Consumer Guidance & Cost Commentary
For the Physical therapy (functional capacity test) service at Medicine Lodge Memorial Hospital in Medicine Lodge, KS, the cash price is $83.00, which matches the facility's cash median. While the hospital is a Critical Access Hospital owned by a Government Hospital District, patients should note that commercial insurance negotiated rates often exceed cash prices due to administrative overhead. For instance, Tricare's negotiated range is $56 to $77, and Humana's is $64 to $88, both of which can be higher than the cash rate depending on the specific plan. If you have a high-deductible plan, paying the $83.00 cash price upfront may result in significant savings compared to your insurance paying their negotiated rate while you cover the deductible.
To ensure you are not overcharged, it is crucial to request a full itemized billing audit before finalizing payment, as over 80% of hospital bills contain errors such as unbundled codes or services not rendered. Additionally, you should inquire about "prompt-pay" discounts, which can reduce the bill by 20% to 50% if paid in full within 30 days, effectively bypassing the costly insurance claims cycle. While the data does not provide specific county or state average comparisons for this CPT code, the facility's cash rate of $83.00 serves as a reliable benchmark against which to evaluate any insurance allowed amounts or negotiated fees to avoid unexpected balance billing.