CMS Price Transparency Data

Physical therapy (functional capacity test)

Facility: West Kendall Baptist Hospital

Billing Code: 97750 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97750
Insurance Median: $338
Cash Discount Price: $579
vs. Medicare Baseline: 10.02x Medicare

The contracted insurance negotiated median rate for a Physical therapy (functional capacity test) at West Kendall Baptist Hospital is $338. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $579. Compared to the federal Medicare reimbursement reference rate of $33.73, this hospital’s rate is 10.02x the Medicare baseline. Located in 9555 Sw 162 Ave, Miami, FL.

Cash / Self-Pay

$579

Average discount available for prompt cash payment at this facility.

Insurance Median

$338

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: $579 (1717%)

Insurance Median: $338 (1002%)

Cash: $579 (1717% of Medicare)

Ins. Median: $338 (1002% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 1002% of the Medicare baseline (a markup of 902%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Amerigroup	$22	65%
Medicaid / KanCare	$22 - $24	65%
Aetna	$23 - $712	68%
Sunshine State	$23	68%
UnitedHealthcare	$23 - $890	68%
Vista	$23	68%
Wellcare	$23	68%
Medicare (plans)	$35 - $47	104%
Blue Cross Blue Shield	$36 - $577	107%
Medica Health Plan	$37	110%
Avmed	$38 - $433	113%
Humana	$38	113%
Leon Medical	$39	116%
Cigna	$40 - $712	119%
Non Contracted	$327	969%
Amerihealth	$400	1186%
International	$578	1714%
Dimension Health Plan	$668 - $801	1980%
Affordable	$801	2375%
Phcs	$801	2375%
Quality Health	$801	2375%

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 $579.
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 West Kendall Baptist Hospital 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.