Physical therapy (functional capacity test)
Facility: Mercy Specialty Hospital Southeast Kansas
Billing Code: 97750 (CPT)
- CPT Billing Code: 97750
- Insurance Median: $90
- Cash Discount Price: $88
- vs. Medicare Baseline: 2.67x 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 267% of the Medicare baseline (a markup of 167%). 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 |
|---|---|---|
| Blue Cross Blue Shield | $18 - $41 | 53% |
| Medicaid / KanCare | $18 - $31 | 53% |
| Aetna | $29 - $72 | 86% |
| UnitedHealthcare | $29 - $133 | 86% |
| Tricare | $31 | 92% |
| Qual Choice Contracted [320325] | $31 | 92% |
| Centivo Contracted [320505] | $31 | 92% |
| Pace Of The Ozarks Contracted [320518] | $31 | 92% |
| Medicare (plans) | $31 | 92% |
| Cigna | $31 - $111 | 92% |
| Kindful Hospice Contracted [320434] | $31 | 92% |
| Mercy Hospice Okc [20252] | $31 | 92% |
| Halo Hcr Inc Hospice Contracted [320432] | $31 | 92% |
| Dept Of Veteran Affairs Contracted [320106] | $31 | 92% |
| Cross Timbers Hospice [20098] | $31 | 92% |
| Kindful Hospice [20434] | $31 | 92% |
| Mercy Mgd Behavioral Health Contracted [320259] | $31 | 92% |
| Humana | $31 | 92% |
| Globalhealth Contracted [320145] | $31 | 92% |
| Cherokee Nation Health Serv Contracted [320066] | $31 | 92% |
| Halo Hcr Inc Hospice [20432] | $31 | 92% |
| Medical Associates Health Contracted [320444] | $31 | 92% |
| Elara Caring Aspire Hospice [20433] | $31 | 92% |
| Provider Partners Health Plans Contracted [320450] | $33 | 98% |
| Medica Contracted [320239] | $47 - $52 | 139% |
| Providrs Care Network Contracted [320484] | $60 | 178% |
| First Health Contracted [320128] | $64 - $72 | 190% |
| Point C Contracted [320238] | $64 - $108 | 190% |
| Mercy Benefit Admin Contracted [320251] | $77 - $101 | 228% |
| Show-Me Health Administrators Contracted [320483] | $77 - $86 | 228% |
| Ebms Contracted [320493] | $90 - $101 | 267% |
| Edison Health Solutions Contracted [320502] | $90 - $101 | 267% |
| Reflect Health Contracted [320492] | $90 - $101 | 267% |
| American Healthcare Alliance Contracted [320020] | $90 - $101 | 267% |
| Yuzu Health Contracted [320521] | $90 - $101 | 267% |
| Aither Health Contracted [320449] | $90 - $101 | 267% |
| Imagine 360 Contracted [320494] | $90 - $101 | 267% |
| Auxiant Contracted [320462] | $90 - $108 | 267% |
| Healthscope Contracted [320182] | $96 - $108 | 285% |
| Healthlink Contracted [320179] | $96 - $108 | 285% |
| Insurance System Inc Contracted [320465] | $96 - $108 | 285% |
| Federal Medical Center Contracted [320127] | $96 - $108 | 285% |
| Health Systems Inc Contracted [320174] | $96 - $108 | 285% |
| United Medical Resources Contracted [320454] | $96 - $108 | 285% |
| Benefit Management Contracted [320052] | $96 - $108 | 285% |
| Preferred Health Plan Contracted [320522] | $96 - $108 | 285% |
| Compcare Of The Ozarks Contracted [320437] | $101 - $114 | 299% |
| Workers Comp [20426] | $102 - $115 | 302% |
| Private Health Care Systems Contracted [320320] | $118 - $133 | 350% |
| Multiplan [20270] | $122 - $137 | 362% |
| Multiplan Contracted [320270] | $122 - $137 | 362% |
Consumer Guidance & Cost Commentary
For the Physical therapy (functional capacity test) service (CPT 97750), the facility's cash price of $88.00 is significantly lower than the negotiated rates paid by most major insurance payers, which range from $18 to $133 depending on the plan. While the facility's cash rate is higher than the state-wide cash median of $88.00 (indicating it aligns with the state average), it is notably lower than the median negotiated payment of $90.00 and the Medicare benchmark of $33.73. This pricing structure suggests that for patients with high-deductible plans or those without insurance, paying the cash price directly may result in lower out-of-pocket costs compared to having insurance process the claim, as the negotiated rates often exceed the cash price. However, patients should verify their specific plan's allowed amount, as some commercial payers may negotiate rates that are higher than the cash option, making self-pay the most economical choice in this instance.
To ensure you are not overcharged, it is critical to request a full itemized bill before paying, as summary bills can obscure individual line items and potential errors. If you receive a balance bill for the difference between the facility's chargemaster rate and your insurance's allowed amount, you may be protected under the No Surprises Act, which bans balance billing for emergency care and non-emergency services at in-network facilities. Additionally, since the facility offers a prompt-pay discount for upfront payment, you should contact the billing department prior to scheduling your visit to confirm if a self-pay classification can be applied to your account. This proactive step can help you secure the $88.00