Physical therapy (functional capacity test)
Facility: Republic County Hospital
Billing Code: 97750 (CPT)
- CPT Billing Code: 97750
- Insurance Median: $102
- Cash Discount Price: $86
- vs. Medicare Baseline: 3.02x 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 302% of the Medicare baseline (a markup of 202%). 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 |
|---|---|---|
| Rural Carriers-All Plans | $76 - $118 | 225% |
| Aetna | $81 - $125 | 240% |
| Meritain-All Plans | $81 - $125 | 240% |
| UnitedHealthcare | $83 - $128 | 246% |
| Cigna | $86 - $132 | 255% |
| Midlands Choice-All Plans | $86 - $132 | 255% |
| First Health-All Plans | $86 - $132 | 255% |
Consumer Guidance & Cost Commentary
For the Physical therapy (functional capacity test) procedure at Republic County Hospital in Belleville, KS, the cash price of $86.00 is lower than the facility's negotiated rates, which average $102.00 across seven commercial payers. This price difference highlights a common billing dynamic where commercial contracts often exceed cash prices due to administrative overhead and claim processing costs. Patients with high-deductible plans may find it financially advantageous to pay the cash price directly, as the $86.00 rate is significantly lower than the $102.00 amount insurers typically negotiate. To secure this lower rate, patients should explicitly request a "self-pay" or "prompt-pay" discount before scheduling services and sign a waiver preventing the hospital from submitting claims to their insurance, thereby bypassing the higher negotiated ceiling.
When evaluating the cost of this service, it is important to compare rates against the Medicare benchmark rather than the hospital's full chargemaster list. The Medicare amount for this code is $33.73, which serves as a scientifically validated baseline for the true cost of care, whereas commercial rates often reflect markups ranging from 200% to 300% of this figure. While the facility's cash rate of $86.00 is higher than the Medicare amount, it remains below the median paid amount of $102.00 observed across commercial payers. Consumers should be aware that balance billing is generally prohibited for out-of-network services at in-network facilities under the No Surprises Act, but patients should still request a detailed, itemized bill to ensure no unbundled codes or services not rendered are included in the final invoice.