CMS Price Transparency Data

Physical therapy (functional capacity test)

Facility: Guadalupe Regional Medical Center

Billing Code: 97750 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97750
Insurance Median: $57
Cash Discount Price: $63
vs. Medicare Baseline: 1.69x Medicare

The contracted insurance negotiated median rate for a Physical therapy (functional capacity test) at Guadalupe Regional Medical Center is $57. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $63. Compared to the federal Medicare reimbursement reference rate of $33.73, this hospital’s rate is 1.69x the Medicare baseline. Located in 1215 E Court St, Seguin, TX.

Cash / Self-Pay

$63

Average discount available for prompt cash payment at this facility.

Insurance Median

$57

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$33.73

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $33.73 (100%)

Cash / Self-Pay: $63 (187%)

Insurance Median: $57 (169%)

Cash: $63 (187% of Medicare)

Ins. Median: $57 (169% of 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.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

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	$32 - $112	95%
Christus Exchange Health Plan	$32 - $47	95%
Mcr Clover Health	$32 - $47	95%
Mcr Texas Independence Health	$32 - $47	95%
Mcr Wellcare	$32 - $47	95%
Oscar Health Plan	$32 - $47	95%
Va Triwest Health Alliance	$32 - $47	95%
Superior Hlth Plan Mmcd	$57 - $59	169%
Healthcare Highways	$94 - $99	279%
UnitedHealthcare	$94 - $99	279%
Humana	$107 - $112	317%
Cigna	$113 - $119	335%
Texas Mutual Insurance Co	$113 - $119	335%
Blue Cross Blue Shield	$133 - $148	394%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $63.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 97750.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Guadalupe Regional Medical Center is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 97750.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.