Physical therapy (functional capacity test)
Facility: William Newton Hospital
Billing Code: 97750 (CPT)
- CPT Billing Code: 97750
- Insurance Median: $49
- Cash Discount Price: $135
- vs. Medicare Baseline: 1.45x 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.
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 |
|---|---|---|
| Triwest- All Plans | $47 | 139% |
| UnitedHealthcare | $48 - $122 | 142% |
| Blue Cross Blue Shield | $48 - $51 | 142% |
| Ambetter / Centene | $48 - $136 | 142% |
| Providrs Care Nexus | $82 - $83 | 243% |
| Providrs Care - All Other Plans | $93 - $95 | 276% |
Consumer Guidance & Cost Commentary
For the Physical therapy (functional capacity test) procedure at William Newton Hospital in Winfield, KS, the cash price is $135.00, which matches the facility's median negotiated rate of $49.00. While the hospital's cash price is significantly higher than the state average of $49.00, it is important to note that commercial insurance negotiated rates often exceed cash prices due to administrative overhead and contract structures. For patients with high-deductible plans, paying the cash price of $135.00 upfront may be more cost-effective than relying on insurance, as the insurer's allowed amount could be higher than the cash rate. Additionally, patients should verify if the facility offers "self-pay" or "prompt-pay" discounts, which can reduce the final bill by 20% to 50% if paid in full within a short window.
The Medicare benchmark for this service is $33.73, serving as a baseline for fair pricing; commercial rates are typically marked up significantly above this figure. Although the facility is a Critical Access Hospital with a government-local ownership structure, the median paid amount by insurers is $49.00, which aligns with the state average. Patients should be aware of balance billing risks if they receive out-of-network care, though the No Surprises Act protects against surprise bills for emergency services at in-network facilities. To ensure accuracy, consumers should request an itemized billing audit to review every charge and confirm that no services were unbundled or incorrectly billed before finalizing payment.