Physical therapy (functional capacity test)
Facility: Hiawatha Community Hospital
Billing Code: 97750 (CPT)
- CPT Billing Code: 97750
- Insurance Median: $160
- Cash Discount Price: $206
- vs. Medicare Baseline: 4.74x 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 474% of the Medicare baseline (a markup of 374%). 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 | $51 - $54 | 151% |
| UnitedHealthcare | $76 - $177 | 225% |
| Aetna | $76 - $166 | 225% |
| Humana | $77 | 228% |
| Ambetter / Centene | $91 | 270% |
| Oscar - All Plans | $154 | 457% |
| Centrus Health Direct - All Plans | $154 | 457% |
| Preferred Hlth - All Plans | $185 | 548% |
| Wppa Providrs Care - All Plans | $196 | 581% |
| Cigna | $196 | 581% |
| Multiplan - All Plans | $200 | 593% |
| Midlands Choice - All Plans | $200 | 593% |
| Healthy Blue Mcaid - All Plans | $206 | 611% |
Consumer Guidance & Cost Commentary
For the CPT code 97750, representing a physical therapy functional capacity test, Hiawatha Community Hospital in Hiawatha, KS, lists a cash price of $206.00. This cash rate matches the facility's maximum negotiated rate and is identical to the Medicare amount of $33.73 when adjusted for the state's specific benchmarking factors, resulting in a 4.7x markup relative to the Medicare baseline. While the facility is a Critical Access Hospital with a voluntary non-profit ownership structure, the cash price is notably higher than the median negotiated rate of $160.00 observed across payer contracts. Patients with high-deductible plans may find this cash price advantageous if their insurance negotiated rates exceed $206.00, as paying out-of-pocket could result in lower total costs compared to insurance processing fees and administrative overhead.
The data indicates that while the facility's cash rate is competitive against the $166.00 median paid by insurers, it is significantly higher than the $160.00 median negotiated rate. Consumers should be aware that hospitals often issue summary bills that obscure individual line items, making it difficult to identify errors or unbundled charges; requesting a full itemized CPT-coded statement is the most effective way to audit the bill and ensure accuracy. Additionally, patients should proactively inquire about "self-pay" or "prompt-pay" discounts before scheduling services, as these upfront payment incentives can reduce the final balance by 20% to 50% by bypassing costly claims processing. Since the No Surprises Act prohibits balance billing for out-of-network providers at in-network facilities, patients should verify their network status