Physical therapy (functional capacity test)
Facility: Kansas City Orthopaedic Institute
Billing Code: 97750 (CPT)
- CPT Billing Code: 97750
- Insurance Median: $104
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 3.08x 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 308% of the Medicare baseline (a markup of 208%). 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 |
|---|---|---|
| Cigna | $43 - $125 | 127% |
| Aetna | $43 | 127% |
| UnitedHealthcare | $43 - $124 | 127% |
| Blue Cross Blue Shield | $66 - $120 | 196% |
| Medica | $172 | 510% |
Consumer Guidance & Cost Commentary
For the Physical therapy (functional capacity test) procedure at Kansas City Orthopaedic Institute in Leawood, KS, the facility's negotiated rates range from $43 to $172 across five major payers, with a median negotiated amount of $104.00. This commercial rate is significantly higher than the Medicare benchmark of $33.73, reflecting the standard administrative markup inherent in insurance contracts. While the facility is an Acute Care Hospital owned by a physician group, patients should be aware that cash-pay options are not listed in this report; however, it is always advisable to contact the billing department directly to inquire about self-pay or prompt-pay discounts, which can sometimes result in lower out-of-pocket costs than the insurance negotiated rate, particularly for those with high-deductible plans.
When reviewing your final bill, ensure you are comparing the facility's rates against the broader market rather than the inflated chargemaster list. The data indicates a wide variance in allowed amounts by payer, with UnitedHealthcare and Blue Cross Blue Shield showing ranges up to $125 and $120 respectively, while Aetna and Medica have fixed rates of $43 and $172. If you receive a balance bill for the difference between the provider's full charge and your insurance allowed amount, you may be entitled to protections under the No Surprises Act, especially if the care was provided at an in-network facility. Furthermore, if your bill contains broad category totals, request a full itemized audit to identify any unbundled codes or services not rendered, as over 80% of hospital bills contain errors that can be corrected through a formal written dispute.