Physical therapy (functional capacity test)
Facility: Osborne County Memorial Hospital
Billing Code: 97750 (CPT)
- CPT Billing Code: 97750
- Insurance Median: $85
- Cash Discount Price: $80
- vs. Medicare Baseline: 2.52x 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 252% of the Medicare baseline (a markup of 152%). 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 |
|---|---|---|
| UnitedHealthcare | $71 | 210% |
| Health Partners Of Kansas | $81 | 240% |
| Wppa | $89 | 264% |
| Blue Cross Blue Shield | $92 | 273% |
Consumer Guidance & Cost Commentary
For the Physical therapy (functional capacity test) procedure at Osborne County Memorial Hospital, the cash price is $80.00, which is lower than the facility's negotiated rates of $85.00 and the highest commercial payer rate of $94.00. While the facility is a Critical Access Hospital in Osborne, KS, this service is not compared to state or county averages in the provided data. Patients with high-deductible plans may find paying the cash price of $80.00 more cost-effective than using insurance, as the negotiated rates exceed the cash amount. To secure the lowest possible cost, patients should explicitly ask the hospital about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront payment incentives can further reduce the final bill.
It is important to understand that commercial insurance rates often include administrative overhead, making them higher than cash prices even when the facility is in-network. If you choose to use insurance, be aware that the facility's negotiated rate of $85.00 serves as a ceiling, but the actual amount your specific plan pays may vary based on your deductible status. Furthermore, if you receive care from an out-of-network provider at this facility, the No Surprises Act protects you from balance billing for emergency and non-emergency services. If you do receive a surprise bill, you should dispute it in writing with the insurer rather than paying immediately, and always request a full itemized CPT-coded bill to ensure no unbundled charges or services not rendered are included.