CMS Price Transparency Data

Physical therapy (functional capacity test)

Facility: Adventist Health and Rideout

Billing Code: 97750 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97750
Insurance Median: $162
Cash Discount Price: $49
vs. Medicare Baseline: 4.80x Medicare

The contracted insurance negotiated median rate for a Physical therapy (functional capacity test) at Adventist Health and Rideout is $162. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $49. Compared to the federal Medicare reimbursement reference rate of $33.73, this hospital’s rate is 4.80x the Medicare baseline. Located in 726 4Th St, Marysville, CA.

Cash / Self-Pay

$49

Average discount available for prompt cash payment at this facility.

Insurance Median

$162

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: $49 (145%)

Insurance Median: $162 (480%)

Cash: $49 (145% of Medicare)

Ins. Median: $162 (480% 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 480% of the Medicare baseline (a markup of 380%). 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
Kaiser Mcal	$16	47%
Medi-Cal	$16	47%
Bc Mcal	$18	53%
Ca Health And Wellness- All Plans	$20	59%
Celtic Mcaid-All Plans	$20	59%
Blue Cross Blue Shield	$36 - $172	107%
Kaiser Mcr Adv	$36	107%
Tricare	$36	107%
UnitedHealthcare	$36 - $194	107%
Healthnet Mcal	$45	133%
Ah Employee Health Plan - All Plans	$64	190%
Aetna	$158	468%
Healthnet Comm-All Other Plans	$162	480%
Kaiser-All Other Plans	$169	501%
Blue Shield Uc Care Members	$178	528%
Cigna	$190	563%
First Health-All Plans	$195	578%
Phcs-All Plans	$196	581%
Interplan-All Plans	$201	596%
Blue Shield-All Other Plans	$212	629%
Multiplan-All Plans	$212	629%
Partnership Hp Mcal -All Plans	$368	1091%

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 $49.
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 Adventist Health and Rideout 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.