CMS Price Transparency Data

Physical therapy (functional capacity test)

Facility: Boston Children's Hospital

Billing Code: 97750 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97750
Insurance Median: $141
Cash Discount Price: $198
vs. Medicare Baseline: 4.18x Medicare

The contracted insurance negotiated median rate for a Physical therapy (functional capacity test) at Boston Children's Hospital is $141. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $198. Compared to the federal Medicare reimbursement reference rate of $33.73, this hospital’s rate is 4.18x the Medicare baseline. Located in 300 Longwood Avenue, Boston, MA.

Cash / Self-Pay

$198

Average discount available for prompt cash payment at this facility.

Insurance Median

$141

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: $198 (587%)

Insurance Median: $141 (418%)

Cash: $198 (587% of Medicare)

Ins. Median: $141 (418% 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 418% of the Medicare baseline (a markup of 318%). 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
Cdphp	$97 - $168	288%
Harvard Pilgrim	$101 - $134	299%
Blue Cross Blue Shield	$112 - $131	332%
Unicare	$115	341%
United	$118 - $165	350%
Aetna	$119 - $166	353%
Mgb/Allways	$120 - $146	356%
Tufts Public Plan	$122	362%
Ambetter / Centene	$125	371%
United Ri Nj Ny	$125	371%
Carelon Strategies/Bhs	$129	382%
UnitedHealthcare	$129 - $168	382%
Carelon/Beacon	$148	439%
Fallon	$151 - $153	448%
Health New England	$160	474%
Cigna	$168 - $179	498%
Ets/Lifetrac	$168	498%
Interlink Transplant	$168	498%
Community Health Options	$178	528%
Humana	$178	528%
Coventry/Hcvm/First Health	$182	540%
Multiplan/Phcs	$182 - $188	540%

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 $198.
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 Boston Children's 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.