Physical therapy (functional capacity test)
Facility: Hospital District #6 Patterson Health Center
Billing Code: 97750 (CPT)
- CPT Billing Code: 97750
- Insurance Median: $81
- Cash Discount Price: $72
- vs. Medicare Baseline: 2.40x 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 240% of the Medicare baseline (a markup of 140%). 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 | $50 - $53 | 148% |
| UnitedHealthcare | $81 - $90 | 240% |
| Providers Care (Wppa)-All Plans | $158 | 468% |
Consumer Guidance & Cost Commentary
For the Physical therapy (functional capacity test) service at Hospital District #6 Patterson Health Center in Anthony, KS, the cash median price is $72.00, which is lower than the negotiated rates of $81.00 typically paid by UnitedHealthcare and Providers Care. While the facility is a Critical Access Hospital with government ownership, patients with high-deductible plans may find paying the cash price directly more cost-effective than relying on insurance, as the commercial negotiated rate exceeds the cash amount. It is important to note that Medicare reimburses $33.73 for this code, meaning the cash price is significantly higher than the federal benchmark, though still below the rates charged by major insurers in this region.
To minimize out-of-pocket expenses, patients should actively request "self-pay" or "prompt-pay" discounts before scheduling, as these upfront payment incentives can reduce the final bill by 20% to 50%. Since the facility is in-network with Blue Cross Blue Shield, UnitedHealthcare, and Providers Care, the No Surprises Act protects patients from balance billing for emergency care and non-emergency services at this location. However, patients must verify their specific plan details and deductible status before treatment, as insurance coverage varies by plan. Always obtain a detailed, itemized bill rather than a summary statement to ensure all charges are accurate and to identify any potential errors before payment.