Physical therapy (functional capacity test)
Facility: Decatur Health
Billing Code: 97750 (CPT)
- CPT Billing Code: 97750
- Insurance Median: $76
- Cash Discount Price: $86
- vs. Medicare Baseline: 2.25x 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 225% of the Medicare baseline (a markup of 125%). 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 |
|---|---|---|
| Wppa/Providrs Care- All Plans | $55 - $60 | 163% |
| UnitedHealthcare | $56 - $76 | 166% |
| Humana | $57 - $61 | 169% |
| Blue Cross Blue Shield | $69 | 205% |
| Aetna | $83 - $99 | 246% |
| Midlands Choice- All Plans | $83 - $89 | 246% |
| Medicaid / KanCare | $93 - $100 | 276% |
Consumer Guidance & Cost Commentary
For the CPT code 97750, representing a physical therapy functional capacity test at Decatur Health in Oberlin, Kansas, the facility's cash median price is $86.00, which is notably higher than the state average of $66.00. While commercial insurance plans like UnitedHealthcare and Aetna have negotiated rates ranging from $55 to $100, these amounts often exceed the cash price due to administrative overhead and contract structures. Patients with high-deductible plans may find it financially advantageous to pay the cash rate of $86.00 directly, as this bypasses the multi-layered billing cycle and potential out-of-pocket costs associated with meeting deductibles before coverage kicks in.
To secure the best possible price, consumers should proactively contact the hospital to inquire about "self-pay" or "prompt-pay" discounts, which can reduce the final bill by 20% to 50% for upfront payment. It is also important to understand that while the facility is a Critical Access Hospital with a voluntary non-profit ownership, the negotiated rates for in-network payers do not automatically represent the lowest possible cost. By comparing the facility's rates against the Medicare benchmark of $33.73, patients can see that the commercial negotiated rates reflect a significant markup, making it essential to verify the exact allowed amount for your specific plan before scheduling to avoid unexpected balance billing or overcharges.