Physical therapy (functional capacity test)
Facility: Nemours Children's Hospital, Delaware
Billing Code: 97750 (CPT)
- CPT Billing Code: 97750
- Insurance Median: $380
- Cash Discount Price: $666
- vs. Medicare Baseline: 11.27x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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 1127% of the Medicare baseline (a markup of 1027%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Tricare | $33 | 98% |
| Us Family Health Plan | $37 | 110% |
| Celtic Transplant | $57 - $666 | 169% |
| Keystone First Hlth Plan | $133 - $295 | 394% |
| Celtic Transplant for De First Health | $233 | 691% |
| UnitedHealthcare | $244 - $416 | 723% |
| Wellpoint Maryland | $246 | 729% |
| Kidz Partners | $252 | 747% |
| Health Partners | $258 | 765% |
| UPMC | $264 | 783% |
| Fidelis | $266 | 789% |
| Aetna | $283 - $386 | 839% |
| Blue Cross Blue Shield | $294 - $588 | 872% |
| Priority Partners John Hopkins | $327 | 969% |
| Six Degrees Health Transplant | $333 | 987% |
| Cigna | $366 - $420 | 1085% |
| Great West-One Health Plan | $366 - $420 | 1085% |
| Amerihealth Caritas Delaware | $380 | 1127% |
| Ambetter / Centene | $380 | 1127% |
| Integra Administrative Group | $400 | 1186% |
| Geisinger Health Plan | $400 | 1186% |
| Six Degrees Health | $433 | 1284% |
| Star Healthcare Network | $433 | 1284% |
| National Transplant Network (Ntn) | $433 | 1284% |
| Life Trac Solid Organ and Bmt Transplant | $466 | 1382% |
| Insurance Administrators of America | $633 | 1877% |
| Three Rivers Provider Network | $633 | 1877% |
| First Health Network | $633 | 1877% |
| Multiplan | $633 | 1877% |
| Private Healthcare Systems | $633 | 1877% |
| Interlink Transplant Network | $633 | 1877% |
| Preferred Healthcare | $633 | 1877% |
| Carefirst Md Community Health Plan | $681 | 2019% |