Physical therapy (functional capacity test)
Facility: Wamego Health Center
Billing Code: 97750 (CPT)
- CPT Billing Code: 97750
- Insurance Median: $28
- Cash Discount Price: $64
- vs. Medicare Baseline: 0.83x 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 |
|---|---|---|
| Medicaid / KanCare | $18 - $28 | 53% |
| UnitedHealthcare | $18 | 53% |
| Aetna | $18 | 53% |
| Providrs Care | $41 | 122% |
| Blue Cross Blue Shield | $70 - $74 | 208% |
Consumer Guidance & Cost Commentary
For the CPT code 97750, representing a physical therapy functional capacity test, the cash median price at Wamego Health Center is $64.00. This cash rate is significantly higher than the state of Kansas average, which is $33.73, and exceeds the Medicare benchmark of $33.73 by a factor of nearly two. While commercial insurance plans like Medicaid/KanCare, UnitedHealthcare, and Aetna negotiate rates ranging from $18 to $41, these negotiated amounts often remain above the cash price. For patients with high-deductible plans, paying the cash price of $64.00 upfront can sometimes be more cost-effective than relying on insurance, as the insurer's allowed amount may exceed the cash rate. It is advisable to contact the facility directly to confirm if "self-pay" or "prompt-pay" discounts are available, which could further reduce the final cost.
The facility, a Critical Access Hospital in Wamego, KS, reports a median negotiated rate of $28.00 across five payers, though specific negotiated rates vary by plan, with some carriers like Providrs Care listing a rate of $41.00. Because commercial insurance contracts often include administrative overhead and multi-layered pricing structures, the negotiated rates can sometimes be higher than the cash price, making out-of-pocket payment a viable option for those who have met their deductible. Patients should be aware that while the No Surprises Act protects against balance billing for emergency care and non-emergency services from out-of-network providers at in-network facilities, it is crucial to verify the status of all ancillary services. To ensure transparency and avoid unexpected charges,