CMS Price Transparency Data

Physical therapy (functional capacity test)

Facility: HCA Houston Healthcare Tomball

Billing Code: 97750 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97750
Insurance Median: $35
Cash Discount Price: $323
vs. Medicare Baseline: 1.04x Medicare

The contracted insurance negotiated median rate for a Physical therapy (functional capacity test) at HCA Houston Healthcare Tomball is $35. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $323. Compared to the federal Medicare reimbursement reference rate of $33.73, this hospital’s rate is 1.04x the Medicare baseline. Located in 605 Holderrieth, Tomball, TX.

Cash / Self-Pay

$323

Average discount available for prompt cash payment at this facility.

Insurance Median

$35

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: $323 (958%)

Insurance Median: $35 (104%)

Cash: $323 (958% of Medicare)

Ins. Median: $35 (104% 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
Superior Health Plan	$12 - $36	36%
Community Health Choice Mcd	$26 - $58	77%
Oscar	$29 - $87	86%
Aetna	$30 - $165	89%
Blue Cross Blue Shield	$30 - $157	89%
Chc Harris Health	$30 - $34	89%
Cigna	$30 - $34	89%
Devoted Health	$30 - $34	89%
Humana	$30 - $361	89%
Triwest Healthcare Alliance	$30 - $34	89%
United	$30 - $202	89%
Van Lang Ipa	$30 - $34	89%
Wellmed	$30 - $34	89%
American Health Plan	$31 - $36	92%
Integranet Amerigroup Ipa	$31 - $35	92%
Procare Advantage	$31 - $36	92%
Shared Health	$31 - $36	92%
Wellcare	$31 - $35	92%
Molina	$32 - $37	95%
Provider Partners Health Plan Of Texas	$32 - $36	95%
Christus (Usfhp)	$34	101%
Triwest Health Alliance	$34	101%
Verda Health Plan	$39 - $44	116%
Community Health Choice	$43 - $49	127%
Superior	$43 - $52	127%
Molina Healthcare	$64 - $73	190%
Coventry National First Health	$72 - $163	213%

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 $323.
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 HCA Houston Healthcare Tomball 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.