CMS Price Transparency Data

Physical therapy (functional capacity test)

Facility: The Children's Mercy Hospital

Billing Code: 97750 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97750
Insurance Median: $73
Cash Discount Price: $67
vs. Medicare Baseline: 2.16x Medicare

The contracted insurance negotiated median rate for a Physical therapy (functional capacity test) at The Children's Mercy Hospital is $73. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $67. Compared to the federal Medicare reimbursement reference rate of $33.73, this hospital’s rate is 2.16x the Medicare baseline. Located in 2401 Gillham Road, Kansas City, MO.

Cash / Self-Pay

$67

Average discount available for prompt cash payment at this facility.

Insurance Median

$73

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$33.73

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $33.73 (100%)

Cash / Self-Pay: $67 (199%)

Insurance Median: $73 (216%)

Cash: $67 (199% of Medicare)

Ins. Median: $73 (216% of 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.

Consult Patient Advocate

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

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%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $67.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 97750.

Insurance In-Network Protection Plan

Contact your insurance company to confirm The Children's Mercy Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 97750.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.