CMS Price Transparency Data

Physical therapy (functional capacity test)

Facility: Cook Childrens Medical Center Prosper

Billing Code: 97750 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97750
Insurance Median: $90
Cash Discount Price: $147
vs. Medicare Baseline: 2.67x Medicare

The contracted insurance negotiated median rate for a Physical therapy (functional capacity test) at Cook Childrens Medical Center Prosper is $90. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $147. Compared to the federal Medicare reimbursement reference rate of $33.73, this hospital’s rate is 2.67x the Medicare baseline. Located in 4100 W University Drive, Prosper, TX.

Cash / Self-Pay

$147

Average discount available for prompt cash payment at this facility.

Insurance Median

$90

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: $147 (436%)

Insurance Median: $90 (267%)

Cash: $147 (436% of Medicare)

Ins. Median: $90 (267% 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 267% of the Medicare baseline (a markup of 167%). 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
Health Plan W. Uhrip	$28 - $83	83%
Health Plan W/O Uhrip	$28 - $134	83%
Aetna	$40 - $211	119%
Superior Health	$48 - $83	142%
Wellpoint	$50 - $87	148%
Blue Cross Blue Shield	$52 - $224	154%
United Community	$53 - $109	157%
UnitedHealthcare	$63 - $211	187%
Beacon	$66 - $134	196%
El Paso Health First	$66 - $134	196%
Tx Children Health	$66 - $134	196%
Firstcare	$70 - $199	208%
S&W Health	$121 - $209	359%
Cigna	$122 - $211	362%
Healthscope	$122 - $211	362%
Imagine Health	$122 - $211	362%
Humana	$125 - $219	371%
Multiplan	$125 - $216	371%
First Health	$127 - $219	377%
Galaxy Health	$130 - $224	385%
Healthsmart	$130 - $224	385%
Usamco	$133 - $229	394%

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 $147.
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 Cook Childrens Medical Center Prosper 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.