Physical therapy (functional capacity test)
Facility: Mercy Hospital Pittsburg, Inc
Billing Code: 97750 (CPT)
- CPT Billing Code: 97750
- Insurance Median: $41
- Cash Discount Price: $47
- vs. Medicare Baseline: 1.22x 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 - $31 | 53% |
| Blue Cross Blue Shield | $18 - $64 | 53% |
| Medica Contracted [320239] | $27 | 80% |
| UnitedHealthcare | $29 - $49 | 86% |
| Tricare | $30 | 89% |
| Halo Hcr Inc Hospice [20432] | $31 | 92% |
| Elara Caring Aspire Hospice [20433] | $31 | 92% |
| Kindful Hospice [20434] | $31 | 92% |
| Kindful Hospice Contracted [320434] | $31 | 92% |
| Mercy Hospice Okc [20252] | $31 | 92% |
| Ambetter / Centene | $31 | 92% |
| Pace Of The Ozarks Contracted [320518] | $31 | 92% |
| Cross Timbers Hospice [20098] | $31 | 92% |
| Humana | $31 | 92% |
| Aetna | $31 - $62 | 92% |
| Dept Of Veteran Affairs Contracted [320106] | $31 | 92% |
| Medicare (plans) | $31 | 92% |
| Halo Hcr Inc Hospice Contracted [320432] | $31 | 92% |
| Home State Health Plan Contracted [320187] | $31 | 92% |
| American Health Advantage Of Ks Mcr Contracted [320508] | $32 | 95% |
| United Medical Resources Contracted [320454] | $49 | 145% |
| Cigna | $50 - $56 | 148% |
| Health Choice Contracted [320166] | $52 | 154% |
| Healthlink Contracted [320179] | $58 | 172% |
| Yuzu Health Contracted [320521] | $58 | 172% |
| Imagine 360 Contracted [320494] | $58 | 172% |
| Ebms Contracted [320493] | $58 | 172% |
| Aither Health Contracted [320449] | $58 | 172% |
| Edison Health Solutions Contracted [320502] | $58 | 172% |
| Reflect Health Contracted [320492] | $58 | 172% |
| American Healthcare Alliance Contracted [320020] | $58 | 172% |
| Workers Comp [20426] | $58 | 172% |
| Auxiant Contracted [320462] | $58 | 172% |
| Mercy Benefit Admin Contracted [320251] | $58 | 172% |
| Providrs Care Network Contracted [320484] | $60 | 178% |
| First Health Contracted [320128] | $62 | 184% |
Consumer Guidance & Cost Commentary
For this physical therapy functional capacity test, the facility's cash price of $47.00 is lower than the state average of $73.00, making it a potentially cost-effective option for self-pay patients. While many commercial payers negotiate rates ranging from $18 to $64, these negotiated amounts often exceed the cash price due to administrative overhead and contract structures. Patients with high-deductible plans may find that paying the cash rate upfront is more economical than having insurance cover the service, as the negotiated allowed amount could be significantly higher than the $47.00 cash price. It is advisable to contact the hospital directly to confirm if "self-pay" or "prompt-pay" discounts are available, which could further reduce the final cost.
The facility's pricing is benchmarked against Medicare, which sets a fixed rate of $33.73 for this procedure. The cash price of $47.00 represents a 1.2x markup over the Medicare amount, which falls within the typical range of 120% to 150% considered fair for commercial pricing. If you are covered by insurance, be aware that your plan's negotiated rate may vary widely; for instance, some plans pay as low as $18 while others pay up to $62. To avoid unexpected costs, request a full itemized bill before paying, as summary bills can obscure individual charges. If you receive a balance bill from an out-of-network provider, you may have protections under the No Surprises Act, and you should dispute any surprise charges in writing rather than accepting them immediately.