CMS Price Transparency Data

Physical therapy (functional capacity test)

Facility: UPMC St Margaret

Billing Code: 97750 (CPT)

The BaseRate · fair price high confidence

A fair price for this

$34

about 1.0× the $34 Medicare rate · typically $28–$53

modeled estimate · not a bill or quote

What this hospital charges insurers

$45

Above the fair price

about $11 over the fair price · 1.3× Medicare

Medicare pays $34 Fair price $34 This hospital $45 Cash price $157 Hospital's list price $261

How we calculate the fair BaseRate →

How this hospital compares to other PA hospitals

Highest price of the 9 PA hospitals we have prices for — worth calling around.

Cheapest $19 Priciest $45

Black dot = this hospital, among the 9 PA hospitals with a price for this procedure. Full list below.

⚠ The cash price looks unusually high next to the insurance price — it may be the full list price, not a real cash discount. Call to confirm the self-pay rate.

A fair price for a Physical therapy (functional capacity test) is about $34 (about 1.0× the $34 Medicare rate). UPMC St Margaret charges insurers about $45, or about $157 in cash — above the fair price. Located in Pittsburgh, PA.

This price is above the fair BaseRate — you may be able to pay less

Ask the hospital for the cash / self-pay price, check whether you qualify for financial assistance, or negotiate the bill down toward the fair price of about $34. Many patients pay well below the first number they’re quoted — the checklists below walk you through it.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

5 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Cigna✓ Humana Kaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$18	53%
Blue Cross Blue Shieldmajor	$25 - $130	74%
Aetnamajor	$65 - $104	193%
Cignamajor	$73 - $104	216%
Humanamajor	$222	658%
AmeriHealth	$26	77%
UPMC Health Plan	$18 - $83	53%
+ 3 smaller / regional plans	$29 - $209

Excludes 1 rental-network / third-party entry (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price (about 157), before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the CPT code on your bill matches exactly: 97750.

Insurance Before you use insurance

Call your insurance company to confirm UPMC St Margaret is in-network.
Ask your insurer whether prior approval is required for CPT code 97750.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at UPMC St Margaret

Compare: Physical therapy (functional capacity test) at other PA hospitals

Insurance negotiated median for the same procedure, sorted lowest first.