CMS Price Transparency Data

Physical therapy (functional capacity test)

Facility: UPMC Hamot

Billing Code: 97750 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97750
Insurance Median: $58
Cash Discount Price: $87
vs. Medicare Baseline: 1.72x Medicare

The contracted insurance negotiated median rate for a Physical therapy (functional capacity test) at UPMC Hamot is $58. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $87. Compared to the federal Medicare reimbursement reference rate of $33.73, this hospital’s rate is 1.72x the Medicare baseline. Located in 201 State Street, Erie, PA.

Cash / Self-Pay

$87

Average discount available for prompt cash payment at this facility.

Insurance Median

$58

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: $87 (258%)

Insurance Median: $58 (172%)

Cash: $87 (258% of Medicare)

Ins. Median: $58 (172% 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.

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
Upmc Health Plan	$18 - $34	53%
UnitedHealthcare	$19 - $139	56%
Aetna	$20 - $102	59%
Univera	$22 - $64	65%
Geisinger	$23	68%
Blue Cross Blue Shield	$25 - $123	74%
Health Partners Plans (Jefferson Health Plan)	$25	74%
Highmark Wholecare (Prev Gateway)	$25 - $72	74%
Amerihealth Caritas	$26	77%
Pa Health & Wellness	$29	86%
Fidelis	$38 - $84	113%
Cigna	$44 - $58	130%
Independent Health	$46 - $49	136%
Upmc Work Partners	$68	202%
Molina Healthcare Of Ny	$84	249%
Intergroup	$94 - $116	279%
Multiplan	$102 - $116	302%

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 $87.
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 UPMC Hamot 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.