CMS Price Transparency Data

Physical therapy (functional capacity test)

Facility: St Louis Childrens Hospital

Billing Code: 97750 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97750
Insurance Median: $143
Cash Discount Price: $121
vs. Medicare Baseline: 4.24x Medicare

The contracted insurance negotiated median rate for a Physical therapy (functional capacity test) at St Louis Childrens Hospital is $143. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $121. Compared to the federal Medicare reimbursement reference rate of $33.73, this hospital’s rate is 4.24x the Medicare baseline. Located in One Childrens Place, Saint Louis, MO.

Cash / Self-Pay

$121

Average discount available for prompt cash payment at this facility.

Insurance Median

$143

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: $121 (359%)

Insurance Median: $143 (424%)

Cash: $121 (359% of Medicare)

Ins. Median: $143 (424% 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 424% of the Medicare baseline (a markup of 324%). 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
Aetna	$32 - $159	95%
Blue Cross Blue Shield	$32 - $171	95%
Essence Healthcare [221]	$32	95%
Humana	$32 - $150	95%
UnitedHealthcare	$32 - $149	95%
Cox Health [757]	$34	101%
Medica [662]	$34	101%
Healthlink [225]	$97 - $152	288%
Cigna	$99 - $109	294%
Apwu Health Plan [216]	$109	323%
Consociate [478]	$109	323%
Nalc Health Benefit Plan [242]	$109	323%
Priority Health [648]	$109	323%
Sarah Bush Lincoln [636]	$109	323%
Cox Health Systems Insurance Company [220]	$111 - $149	329%
Allied Benefits [498]	$117 - $159	347%
Hope Trust [806]	$117	347%
Med-Pay [480]	$131 - $151	388%
Unicare [568]	$131 - $152	388%
Health Alliance [224]	$141	418%
Healthscope Benefits [258]	$143 - $161	424%
First Health Commercial [734]	$149	442%
Beechstreet [551]	$151	448%
Detego Health [868]	$151	448%
Health Systems Inc [620]	$151	448%
Healthcare Sol Mercy [609]	$151	448%
Multiplan Commercial [737]	$151	448%
Multiplan [240]	$151	448%
Phcs [244]	$151 - $161	448%
Preferred Health Professionals [561]	$152	451%
Coresource [497]	$159	471%
Fmh Benefit Service Inc [222]	$159	471%
Mail Handlers [495]	$159	471%
Medica [661]	$161	477%
Hfn [563]	$171	507%

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 $121.
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 St Louis Childrens 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.