CMS Price Transparency Data

Physical therapy (functional capacity test)

Facility: Children's Hospital of Philadelphia

Billing Code: 97750 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97750
Insurance Median: $91
Cash Discount Price: $217
vs. Medicare Baseline: 2.70x Medicare

The contracted insurance negotiated median rate for a Physical therapy (functional capacity test) at Children's Hospital of Philadelphia is $91. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $217. Compared to the federal Medicare reimbursement reference rate of $33.73, this hospital’s rate is 2.70x the Medicare baseline. Located in 3401 Civic Center Blvd, Philadelphia, PA.

Cash / Self-Pay

$217

Average discount available for prompt cash payment at this facility.

Insurance Median

$91

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: $217 (643%)

Insurance Median: $91 (270%)

Cash: $217 (643% of Medicare)

Ins. Median: $91 (270% 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 270% of the Medicare baseline (a markup of 170%). 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
Geisinger Medical Assistance	$23	68%
Medicaid / KanCare	$36	107%
UnitedHealthcare	$36 - $119	107%
Health Partners	$41	122%
Aetna	$57 - $108	169%
Highmark Wholecare	$59	175%
Upmc Medical Assistance	$59	175%
Keystone First Chip	$67	199%
Keystone Health Plan East	$69	205%
Horizon Nj Health	$70	208%
Blue Cross Blue Shield	$76 - $87	225%
Geisinger Health Plan Commercial	$95	282%
Jefferson Health Plans	$102	302%
Cigna	$108	320%
Highmark	$108	320%
Qualcare	$119	353%
First Health Network	$141	418%
Devon Health, Intergroup, Multiplan, Valley Preferred/Populytics	$173	513%
Private Health Care Systems	$173	513%
Choice Care Network	$195	578%

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 $217.
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 Children's Hospital of Philadelphia 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.