Physical therapy (functional capacity test)
Facility: Stevens County Hospital
Billing Code: 97750 (CPT)
- CPT Billing Code: 97750
- Insurance Median: $68
- Cash Discount Price: $79
- vs. Medicare Baseline: 2.02x 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 202% of the Medicare baseline (a markup of 102%). 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 |
|---|---|---|
| Humana | $29 | 86% |
| Aetna | $30 - $79 | 89% |
| Blue Cross Blue Shield | $51 - $54 | 151% |
| First Health - All Plans | $71 | 210% |
| Wppa - All Plans | $75 | 222% |
| Medicaid / KanCare | $79 | 234% |
Consumer Guidance & Cost Commentary
For this Physical therapy (functional capacity test) at Stevens County Hospital in Hugoton, KS, the cash price is $79.00, which matches the facility's negotiated rate for Medicaid and several commercial payers. While the median amount paid by insurance plans is $68.00, patients with high-deductible plans may find paying the full cash price of $79.00 upfront more cost-effective than relying on insurance, as the negotiated rates for some insurers exceed the cash amount. It is important to note that the facility is a Critical Access Hospital with government local ownership, and patients should explicitly ask about "self-pay" or "prompt-pay" discounts before scheduling to ensure they are not automatically enrolled in a billing cycle that includes administrative fees.
When evaluating the cost against national standards, the Medicare benchmark for this service is $33.73, which serves as a baseline for fair pricing. The facility's cash rate of $79.00 represents a 2.0x markup compared to the Medicare amount, which is consistent with the typical range where commercial rates average 200% to 300% of Medicare. Patients should be aware that balance billing is generally prohibited for emergency care and non-emergency services at in-network facilities under the No Surprises Act, but they must still review their itemized bills to ensure no unbundled codes or services not rendered have been charged. If a surprise bill arises, consumers should dispute it in writing with the billing supervisor rather than paying immediately to avoid unnecessary debt.