Physical therapy (functional capacity test)
Facility: Centura St. Catherine-Dodge City
Billing Code: 97750 (CPT)
- CPT Billing Code: 97750
- Insurance Median: $117
- Cash Discount Price: $63
- vs. Medicare Baseline: 3.47x 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.
Elevated Commercial Rate Alert (Value-Gap)
The negotiated rate at this facility is 347% of the Medicare baseline (a markup of 247%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
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 | $34 - $131 | 101% |
| Kaiser | $34 | 101% |
| Medicare (plans) | $34 | 101% |
| Cigna | $34 | 101% |
| Kansas Health | $34 | 101% |
| Humana | $34 | 101% |
| Blue Cross Blue Shield | $34 - $63 | 101% |
| Centura Employee Plan | $72 | 213% |
| UnitedHealthcare | $98 - $108 | 291% |
| Wpaa | $105 - $115 | 311% |
| Multiplan | $120 - $148 | 356% |
| Christian Health Aid | $120 - $131 | 356% |
| Health Partners Of Kansas | $134 - $148 | 397% |
Consumer Guidance & Cost Commentary
For CPT code 97750, representing a physical therapy functional capacity test, the facility's cash median price of $63.00 is significantly lower than the state average of $117.00. While commercial payers negotiate rates that typically range from $34 to $148 depending on the plan, patients with high-deductible or self-pay options may find the cash price most advantageous. It is important to note that insurance negotiated rates often include administrative overhead and contract structures that can inflate the final cost compared to direct cash payment. Before scheduling, patients should verify their specific plan's allowed amount and ask the hospital directly about "self-pay" or "prompt-pay" discounts, which can further reduce the bill by bypassing standard insurance billing cycles.
The facility's Medicare benchmarking rate of $33.73 serves as a critical baseline for evaluating pricing fairness, as commercial negotiated rates frequently exceed this federal standard by a wide margin. In this case, the Medicare amount is approximately 3.5 times the cash price, highlighting that the cash rate is already a substantial discount relative to government reimbursement. To ensure you are not overpaying, request a full itemized billing audit to confirm that no unbundled codes or services not rendered are included in the final charge. Always compare the facility's negotiated rates against the Medicare benchmark rather than the hospital's inflated chargemaster list, as the latter can make discounts appear larger than they actually are.