Physical therapy (functional capacity test)
Facility: Smith County Memorial Hospital
Billing Code: 97750 (CPT)
- CPT Billing Code: 97750
- Insurance Median: $80
- Cash Discount Price: $100
- vs. Medicare Baseline: 2.37x 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 237% of the Medicare baseline (a markup of 137%). 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 |
|---|---|---|
| Medicaid / KanCare | $26 - $100 | 77% |
| Blue Cross Blue Shield | $53 | 157% |
| Multiplan-All Plans | $90 | 267% |
| Wppa-All Plans | $94 | 279% |
| UnitedHealthcare | $95 | 282% |
| Midlands Choice-All Plans | $95 | 282% |
| Health Partners Of Ks Ppo-All Plans | $95 | 282% |
Consumer Guidance & Cost Commentary
For the CPT code 97750, representing a physical therapy functional capacity test, Smith County Memorial Hospital in Smith Center, KS, lists a gross charge of $100.00. The facility's cash median price is $100.00, which matches the gross charge, while the median negotiated rate across payers is $80.00. This facility is a Critical Access Hospital owned by the local government, and its pricing is benchmarked against Medicare, which sets the standard reimbursement at $33.73. The facility's negotiated rates are 2.4 times higher than the Medicare benchmark, reflecting the typical administrative and contractual structures that inflate commercial pricing above the federal baseline.
Patients should be aware that while insurance negotiated rates often appear lower than the gross charge, they can still exceed the cash price depending on the specific plan and deductible status. For this service, the cash price of $100.00 is higher than the median negotiated rate of $80.00, but patients with high-deductible plans or those who have not yet met their out-of-pocket maximum may find the cash option more cost-effective if the insurance allowed amount is significantly lower than the cash price. It is advisable to contact the hospital directly to confirm if "self-pay" or "prompt-pay" discounts are available, as these upfront payment incentives can reduce the final bill by bypassing standard insurance billing cycles and administrative overhead.