CMS Price Transparency Data

Physical therapy (functional capacity test)

Facility: UPMC Children's Hospital of Pittsburgh

Billing Code: 97750 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97750
Insurance Median: $151
Cash Discount Price: $193
vs. Medicare Baseline: 4.48x Medicare

The contracted insurance negotiated median rate for a Physical therapy (functional capacity test) at UPMC Children's Hospital of Pittsburgh is $151. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $193. Compared to the federal Medicare reimbursement reference rate of $33.73, this hospital’s rate is 4.48x the Medicare baseline. Located in One Children's Hospital Drive, Pittsburgh, PA.

Cash / Self-Pay

$193

Average discount available for prompt cash payment at this facility.

Insurance Median

$151

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: $193 (572%)

Insurance Median: $151 (448%)

Cash: $193 (572% of Medicare)

Ins. Median: $151 (448% 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 448% of the Medicare baseline (a markup of 348%). 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	$25 - $177	74%
Upmc Health Plan	$39 - $84	116%
Amerihealth Caritas	$63	187%
Health Partners Plans (Jefferson Health Plan)	$65	193%
UnitedHealthcare	$66 - $151	196%
Highmark Wholecare (Prev Gateway)	$68	202%
Pa Health & Wellness	$68	202%
Geisinger	$69 - $144	205%
Blue Cross Blue Shield	$73 - $160	216%
Cigna	$151 - $177	448%
Health Plan Of Upper Ohio Valley	$209	620%
Intergroup	$209 - $273	620%
Coventry/First Health	$257	762%
Saudi Armed Forces	$257	762%
Health Payors Organization	$273	809%
Multiplan	$273	809%
National Provider Network	$289	857%
Private Health Care Systems	$289	857%

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 $193.
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 Children's Hospital of Pittsburgh 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.