Physical therapy (functional capacity test)
Facility: Memorial Hospital
Billing Code: 97750 (CPT)
- CPT Billing Code: 97750
- Insurance Median: $102
- Cash Discount Price: $150
- 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 |
|---|---|---|
| Tricare | $48 - $102 | 142% |
| Humana | $48 - $102 | 142% |
| Medicare (plans) | $49 - $103 | 145% |
| Ambetter / Centene | $53 - $112 | 157% |
| Blue Cross Blue Shield | $57 | 169% |
| Coventry - All Other Plans | $87 - $184 | 258% |
| Preferred Healthcare-All Plans | $91 - $194 | 270% |
| Health Partners Of Kansas - All Plans | $91 - $194 | 270% |
| Wppa/Providers Care-All Plans | $135 - $286 | 400% |
Consumer Guidance & Cost Commentary
For this Physical therapy (functional capacity test) service at Memorial Hospital in Abilene, KS, the cash price of $150.00 is significantly higher than the state average, which is $97.00. While Medicare benchmarks the service at $33.73, commercial insurance plans negotiate rates that vary widely, ranging from $48 to $286 depending on the carrier. For patients with high-deductible plans, paying the full cash price of $150.00 upfront could be more cost-effective than relying on insurance, as some negotiated rates exceed the cash amount. It is important to verify your specific plan's deductible status before scheduling, as you may be responsible for the full negotiated rate if you have not yet met your out-of-pocket threshold.
Before finalizing payment, patients should proactively ask the hospital about "self-pay" or "prompt-pay" discounts, which can reduce the bill by 20% to 50% for upfront payment. Since hospitals often submit claims to insurance automatically, patients must request a waiver of insurance submission to ensure the cash discount applies. Additionally, if you choose to use insurance, be aware that balance billing is generally prohibited for emergency care and non-emergency services at in-network facilities under the No Surprises Act, though unexpected charges can still occur from out-of-network ancillary services like labs or emergency physicians. Always request a detailed, itemized bill to review specific CPT codes and avoid paying for services that were not rendered or were incorrectly bundled.