Physical therapy (functional capacity test)
Facility: Clay County Medical Center
Billing Code: 97750 (CPT)
- CPT Billing Code: 97750
- Insurance Median: $76
- Cash Discount Price: $80
- 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 |
|---|---|---|
| Aetna | $74 | 219% |
| Wppa/Providrs Care- All Plans | $74 | 219% |
| UnitedHealthcare | $76 | 225% |
| Multiplan- All Plans | $76 | 225% |
| Health Partners - All Plans | $76 | 225% |
Consumer Guidance & Cost Commentary
For the Physical therapy (functional capacity test) procedure at Clay County Medical Center in Clay Center, KS, the cash price is $80.00, which matches the facility's negotiated rate for all five major payers including Aetna, UnitedHealthcare, and WPPA/Providers Care. This cash price is significantly higher than the state average for this service, which is $76.00, and also exceeds the Medicare benchmark of $33.73 by a factor of 2.3. While commercial insurance contracts typically cap charges at negotiated rates, the data indicates that the cash-pay option here is not cheaper than the standard insurance payment, meaning patients with high-deductible plans may not save money by paying out-of-pocket unless the facility offers a specific self-pay or prompt-pay discount.
To ensure you are receiving the most accurate pricing, it is important to request an itemized billing audit before finalizing payment, as summary bills often obscure individual code costs and potential errors. If you choose to use insurance, be aware that the negotiated rate of $76.00 reflects the administrative overhead and contract terms of the payer, which can sometimes be higher than the direct cash price due to multi-layered billing structures. Before scheduling, verify your deductible status and explicitly ask the billing department about any prompt-pay discounts that could reduce the $80.00 charge, as these upfront incentives can bypass costly claims processing delays and administrative fees.