Physical therapy (functional capacity test)
Facility: Saint Luke'S South Hospital
Billing Code: 97750 (CPT)
- CPT Billing Code: 97750
- Insurance Median: $97
- Cash Discount Price: $166
- vs. Medicare Baseline: 2.88x 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 288% of the Medicare baseline (a markup of 188%). 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 |
|---|---|---|
| Medicaid / KanCare | $18 - $44 | 53% |
| Blue Cross Blue Shield | $33 - $93 | 98% |
| UnitedHealthcare | $36 - $127 | 107% |
| Humana | $59 - $88 | 175% |
| Cigna | $75 - $289 | 222% |
| Transplants-Case Rates [5750] | $97 - $276 | 288% |
| First Health [5512] | $164 | 486% |
| Commercial-Contracted [8000] | $203 - $223 | 602% |
| Aetna | $262 | 777% |
Consumer Guidance & Cost Commentary
For the CPT code 97750, representing a physical therapy functional capacity test at Saint Luke's South Hospital in Overland Park, KS, the cash median price is $166.00. This cash rate is notably lower than the facility's negotiated rates, which range from $18 to $289 depending on the insurance carrier. For instance, Medicaid/KanCare plans pay a median of $18 to $44, while UnitedHealthcare plans pay between $36 and $127. When comparing these commercial rates to the Medicare benchmark of $33.73, the facility's cash price is approximately 2.9 times the Medicare amount. Patients with high-deductible plans may find it financially advantageous to pay the cash price of $166.00 directly, as this amount is often lower than the negotiated rates their insurance carriers would pay, which can exceed $200 for certain plans like Cigna and Transplants-Case Rates.
To ensure you are receiving the most accurate and fair pricing, it is crucial to request an itemized billing audit before finalizing payment. Hospitals often issue summary bills that obscure individual charges, but an itemized statement reveals the exact CPT codes and unit costs, allowing you to identify potential errors, unbundled services, or charges for items not rendered. Additionally, while the facility's negotiated rates are generally higher than the cash price, you should inquire about "self-pay" or "prompt-pay" discounts, which can further reduce the total cost by bypassing administrative fees associated with insurance claims. Always verify your specific plan's allowed amount with the hospital prior to scheduling, as assuming that in-network coverage equals the