CMS Price Transparency Data

Physical therapy (functional capacity test)

Facility: UPMC Lititz

Billing Code: 97750 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97750
Insurance Median: $64
Cash Discount Price: $82
vs. Medicare Baseline: 1.90x Medicare

The contracted insurance negotiated median rate for a Physical therapy (functional capacity test) at UPMC Lititz is $64. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $82. Compared to the federal Medicare reimbursement reference rate of $33.73, this hospital’s rate is 1.90x the Medicare baseline. Located in 1500 Highlands Drive, Lititz, PA.

Cash / Self-Pay

$82

Average discount available for prompt cash payment at this facility.

Insurance Median

$64

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: $82 (243%)

Insurance Median: $64 (190%)

Cash: $82 (243% of Medicare)

Ins. Median: $64 (190% 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
Prime Net	$18 - $99	53%
Amerihealth Caritas	$21	62%
Highmark Wholecare (Prev Gateway)	$21	62%
UnitedHealthcare	$22 - $148	65%
Upmc Health Plan	$22 - $96	65%
Aetna	$23 - $64	68%
Health Partners Plans (Jefferson Health Plan)	$23	68%
Geisinger	$24 - $99	71%
Blue Cross Blue Shield	$27 - $64	80%
Keystone Health Plan	$27 - $64	80%
Upmc Work Partners	$70	208%
Preferred Healthcare System	$75 - $103	222%
Multiplan	$116	344%
Cigna	$387	1147%

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 $82.
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 Lititz 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.