Physical therapy (functional capacity test)
Facility: Phillips County Hospital
Billing Code: 97750 (CPT)
- CPT Billing Code: 97750
- Insurance Median: $62
- Cash Discount Price: $58
- vs. Medicare Baseline: 1.84x 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.
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 |
|---|---|---|
| UnitedHealthcare | $54 - $68 | 160% |
| Blue Cross Blue Shield | $54 - $55 | 160% |
| Health Partners-All Plans | $68 | 202% |
| Medicaid / KanCare | $68 | 202% |
Consumer Guidance & Cost Commentary
For the CPT code 97750, representing a physical therapy functional capacity test, the cash median price at Phillips County Hospital is $58.00, while the median amount paid by insurance is $55.00. This specific service is notably cheaper when paid out-of-pocket compared to the facility's negotiated rates with major payers like UnitedHealthcare and Blue Cross Blue Shield, which range from $54.00 to $68.00. Because the cash price is lower than the insurance negotiated rate, patients with high-deductible plans may save money by paying directly, provided they have sufficient funds. It is important to verify if the facility offers a "self-pay" or "prompt-pay" discount for upfront billing, as these incentives can further reduce the final cost.
The facility's pricing structure aligns closely with the Medicare benchmark, with the gross charge of $68.00 representing an 1.8x markup over the Medicare rate of $33.73. While commercial negotiated rates generally average between 200% and 300% of Medicare, this service falls within a more moderate range, suggesting a fairer pricing model for in-network members. However, patients should remain vigilant regarding balance billing if they are out-of-network, as the No Surprises Act protects against unexpected bills for emergency care and non-emergency services at in-network facilities. To ensure accuracy, consumers should request a detailed, itemized bill rather than accepting a summary invoice, which may hide unbundled charges or services not rendered.