Physical therapy (functional capacity test)
Facility: Golden Valley Memorial Hospital
Billing Code: 97750 (CPT)
- CPT Billing Code: 97750
- Insurance Median: $32
- Cash Discount Price: $450
- vs. Medicare Baseline: 0.95x 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 |
|---|---|---|
| Aetna | $31 | 92% |
| Humana | $31 | 92% |
| UnitedHealthcare | $31 - $52 | 92% |
| Home State Health | $32 | 95% |
| Ambetter / Centene | $37 | 110% |
| Medica | $166 | 492% |
Consumer Guidance & Cost Commentary
If you are a self-pay patient, your first priority should be to confirm whether the facility offers a "prompt-pay" discount or a reduced "cash" rate before scheduling any appointments. Based on the data for this Physical therapy (functional capacity test) at Golden Valley Memorial Hospital, the facility lists a cash median rate of $450.00, which is significantly higher than the median negotiated rate of $32.00 paid by commercial payers. This price difference highlights that while insurance contracts cap payments at a much lower level, paying out-of-pocket does not guarantee the lowest possible cost, as the facility's cash rate exceeds the commercial negotiated ceiling.
For broader context, it is important to understand that commercial negotiated rates often include administrative overhead and contractual premiums that can exceed the actual cost of care, whereas Medicare rates serve as a scientifically validated baseline for "true cost." In this specific case, the Medicare amount for this service is $33.73, which is nearly identical to the commercial negotiated rate of $32.00, indicating that the commercial market pricing for this procedure is already very close to the federal benchmark. Patients should be aware that while the cash rate of $450.00 appears high compared to the $32.00 insurance payment, the facility is a Government-owned Acute Care Hospital in Clinton, MO, and should be asked directly about any self-pay or prompt-pay discounts that could bridge the gap between the cash price and the actual cost of service.