Physical therapy (functional capacity test)
Facility: Scott County Hospital
Billing Code: 97750 (CPT)
- CPT Billing Code: 97750
- Insurance Median: $86
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 2.55x 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 255% of the Medicare baseline (a markup of 155%). 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 | $18 - $90 | 53% |
| Humana | $40 | 119% |
| Blue Cross Blue Shield | $54 | 160% |
| Wppa | $57 - $1,200 | 169% |
| Aetna | $86 | 255% |
Consumer Guidance & Cost Commentary
For the CPT code 97750, representing a physical therapy functional capacity test at Scott County Hospital in Scott City, KS, the negotiated rates paid by insurance carriers range from $18 to $1,200, with a median negotiated amount of $86.00. This facility, a voluntary non-profit Critical Access Hospital, has a facility rating of 2. While the data does not provide specific cash or median paid values for this service, patients should be aware that cash-pay options can sometimes be more cost-effective than insurance reimbursement, particularly for those with high-deductible plans where the insurer's allowed amount might exceed the cash price. It is advisable to contact the hospital directly to inquire about self-pay or prompt-pay discounts, which can significantly reduce out-of-pocket costs before scheduling any appointments.
When reviewing your bill, it is important to distinguish between the hospital's gross charges and the actual amount your insurance will cover. The Medicare benchmark for this service is $33.73, which serves as a baseline for evaluating pricing fairness; commercial negotiated rates often exceed this figure due to administrative overhead and contract dynamics. If you receive a bill that includes balance billing—where the provider charges the difference between their full list price and your insurance payment—ensure you understand your rights under the No Surprises Act, which prohibits such billing for emergency care and non-emergency services at in-network facilities. Furthermore, if you receive a summary bill, request a full itemized audit to identify any unbundled codes or services not rendered, as over 80% of hospital bills contain errors that can be corrected through a formal written dispute.