CMS Price Transparency Data

Physical therapy (functional capacity test)

Facility: Ascension Seton Hays

Billing Code: 97750 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97750
Insurance Median: $32
Cash Discount Price: $59
vs. Medicare Baseline: 0.95x Medicare

The contracted insurance negotiated median rate for a Physical therapy (functional capacity test) at Ascension Seton Hays is $32. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $59. Compared to the federal Medicare reimbursement reference rate of $33.73, this hospital’s rate is 0.95x the Medicare baseline. Located in 6001 Kyle Pkwy, Kyle, TX.

Cash / Self-Pay

$59

Average discount available for prompt cash payment at this facility.

Insurance Median

$32

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: $59 (175%)

Insurance Median: $32 (95%)

Cash: $59 (175% of Medicare)

Ins. Median: $32 (95% 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
Aarp Mc Wellmed	$32	95%
Addr Cancer Together	$32	95%
Aetna	$32	95%
Covid Hrsa	$32	95%
Cshcn Cidc	$32	95%
Devoted Health Mcr Replacement	$32	95%
Humana	$32	95%
Medicare (plans)	$32	95%
Research Study	$32	95%
Sendero Chap	$32	95%
Smarthealth	$32	95%
Superior Allwell	$32	95%
Tricare	$32 - $34	95%
Utmb	$32	95%
Wellcare Med Advantage	$32	95%
Connected Senior Care	$33	98%
UnitedHealthcare	$33	98%
Champva	$34 - $39	101%
Pphp Mcr Advantage	$34	101%
Tx Independence Hp	$34	101%
Occunet	$45	133%
Sendero Idealcare	$56	166%
Ambetter / Centene	$58	172%
Blue Cross Blue Shield	$61 - $148	181%

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 $59.
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 Ascension Seton Hays 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.