Physical therapy (functional capacity test)
Facility: Trego County Lemke Memorial Hospital
Billing Code: 97750 (CPT)
- CPT Billing Code: 97750
- Insurance Median: $73
- Cash Discount Price: $81
- vs. Medicare Baseline: 2.16x 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 216% of the Medicare baseline (a markup of 116%). 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 | $47 | 139% |
| Tricare | $50 | 148% |
| Medicaid / KanCare | $59 - $95 | 175% |
| Aetna | $59 - $86 | 175% |
| UnitedHealthcare | $59 - $95 | 175% |
| Va Ccn - All Plans | $59 | 175% |
| Ambetter / Centene | $65 | 193% |
| Blue Cross Blue Shield | $73 | 216% |
| Health Partners - All Plans | $90 | 267% |
| Healthy Blue Mcaid - All Plans | $95 | 282% |
Consumer Guidance & Cost Commentary
For the Physical therapy (functional capacity test) procedure, the gross charge at Trego County Lemke Memorial Hospital is $95.00, with a cash median of $81.00. While the facility's negotiated rates range from $47.00 to $95.00 across ten payers, the cash price of $81.00 is notably lower than the median negotiated rate of $73.00 reported for this service. Patients with high-deductible plans or those without insurance may find the cash price more favorable than their specific insurance allowed amounts, which can sometimes exceed the cash rate. It is important to note that while the facility is a Critical Access Hospital in Wakeeney, KS, the data does not provide specific county or state average benchmarks for this procedure to make direct comparisons.
To minimize unexpected costs, patients should verify their specific insurance allowed amounts before scheduling, as commercial negotiated rates vary significantly by plan. Although the No Surprises Act protects patients from balance billing for out-of-network services at in-network facilities, it is still advisable to request an itemized bill to ensure no unbundled codes or services not rendered are included. If you choose to pay out-of-pocket, ask the billing department about prompt-pay discounts, which can reduce the final amount by 20% to 50% if settled upfront. Always confirm whether your plan has met its deductible before relying on insurance coverage, as paying the full negotiated rate without meeting this threshold can result in higher out-of-pocket expenses than paying the cash price directly.