Physical therapy (functional capacity test)
Facility: Children'S Mercy South
Billing Code: 97750 (CPT)
- CPT Billing Code: 97750
- Insurance Median: $73
- Cash Discount Price: $67
- vs. Medicare Baseline: 2.16x 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 216% of the Medicare baseline (a markup of 116%). 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 | $14 - $107 | 42% |
| UnitedHealthcare | $18 - $103 | 53% |
| Healthy Blue | $20 - $89 | 59% |
| Medicaid / KanCare | $21 - $30 | 62% |
| Home State Health | $32 - $78 | 95% |
| Wppa Providrs Care | $39 - $100 | 116% |
| Quiktrip | $40 - $100 | 119% |
| Blue Cross Blue Shield | $41 - $114 | 122% |
| Healthlink | $42 - $136 | 125% |
| Health Midwest Comprehensive Care | $45 - $100 | 133% |
| American Healthcare Alliance | $48 - $131 | 142% |
| Aetna | $50 - $105 | 148% |
| Multiplan | $51 - $117 | 151% |
| Humana | $59 - $102 | 175% |
| Orscheln | $60 - $100 | 178% |
| Wellfit/Centrus | $62 - $100 | 184% |
| Centivo | $64 - $100 | 190% |
| Coventry Health Care Of Kansas | $64 - $114 | 190% |
| Nebraska Furniture Mart | $65 - $100 | 193% |
| Medica | $73 - $90 | 216% |
| Mercy Health | $91 - $116 | 270% |
| Coxhealth Network | $92 - $114 | 273% |
| National Preferred Provider Network | $110 - $139 | 326% |
Consumer Guidance & Cost Commentary
For the CPT code 97750, representing a physical therapy functional capacity test, Children's Mercy South in Overland Park, KS, lists a cash median price of $67.00. This cash rate is significantly lower than the facility's negotiated rates, which range from $14 to $139 depending on the insurance carrier. While the facility's negotiated rates are higher than the cash price, patients with high-deductible plans may find the cash option more cost-effective if their insurance allowed amount exceeds $67.00. It is important to note that commercial negotiated rates often include administrative overhead and contract markups, and patients should verify their specific plan's allowed amount before scheduling to ensure they are not paying more than necessary.
The facility's cash price of $67.00 is notably lower than the state average for this service, which is $73.00. Additionally, the cash rate is less than half of the Medicare benchmark of $33.73 when adjusted for the facility's specific location and cost structure, though the reported vs. Medicare ratio of 2.2 suggests the facility's pricing model differs from the standard federal baseline. To minimize costs, patients should explicitly request a self-pay or prompt-pay discount prior to check-in, as hospitals often offer fee reductions of 20% to 50% for upfront payments that bypass insurance billing cycles. If a large bill is received after insurance processing, patients should demand a full itemized CPT-coded statement to identify any errors, unbundled charges, or services not rendered before negotiating payment.