CMS Price Transparency Data
Physical therapy (functional capacity test)
Facility: Watsonville Community Hospital
Billing Code: 97750 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 97750
- Insurance Median: $213
- Cash Discount Price: $213
- vs. Medicare Baseline: 6.31x Medicare
The contracted insurance negotiated median rate for a Physical therapy (functional capacity test) at Watsonville Community Hospital is $213. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $213. Compared to the federal Medicare reimbursement reference rate of $33.73, this hospital’s rate is 6.31x the Medicare baseline. Located in 75 Nielson Street, Watsonville, CA.
Cash / Self-Pay
$213
Average discount available for prompt cash payment at this facility.
Insurance Median
$213
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: $213 (631%)
Insurance Median: $213 (631%)
Cash: $213 (631% of Medicare)
Ins. Median: $213 (631% 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 631% of the Medicare baseline (a markup of 531%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
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Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| California Childrens Srvs | $15 - $17 | 44% |
| Ccs/Monterey County | $15 - $17 | 44% |
| Healthy Families | $15 - $17 | 44% |
| Medi-Cal E.R. | $15 - $17 | 44% |
| Medi-Cal/Eds | $15 - $17 | 44% |
| Medicaid / KanCare | $15 - $17 | 44% |
| Well Path | $15 - $356 | 44% |
| Alliance/Sccho | $17 - $28 | 50% |
| Ace-Usa | $37 | 110% |
| Beta Healthcare Group | $37 | 110% |
| Blue Shield Ppo | $37 | 110% |
| Crawford & Co | $37 | 110% |
| Fireman'S Fund Work Comp | $37 | 110% |
| Fleming & Associates | $37 | 110% |
| Gallagher Bassett Svcs | $37 | 110% |
| Hartford Workers' Comp | $37 | 110% |
| Keenan & Assoc Work Comp | $37 | 110% |
| Kemper Group Workers Comp | $37 | 110% |
| Liberty Mutual Work Comp | $37 | 110% |
| Medicare (plans) | $37 - $38 | 110% |
| Miscellaneous Work Comp | $37 | 110% |
| Pinnacle Healthcare Uc | $37 | 110% |
| Republic Idemnity W/Comp | $37 | 110% |
| Travelers Insurance | $37 - $356 | 110% |
| Tricare | $37 | 110% |
| U.S. Dept. Of Labor | $37 | 110% |
| Veterans Administration | $37 | 110% |
| Western Growers Work Comp | $37 | 110% |
| Workers Comp | $37 | 110% |
| Alignment Health Plan | $38 | 113% |
| Health Net Of California | $38 - $223 | 113% |
| Secure Horizons | $38 | 113% |
| Secure Horizons Dign Hmo | $38 - $71 | 113% |
| UnitedHealthcare | $38 - $213 | 113% |
| Medicruz | $64 | 190% |
| Victim Compensation Plan | $64 - $356 | 190% |
| Aetna | $71 - $292 | 210% |
| Blue Cross Blue Shield | $71 - $317 | 210% |
| Blue Shield Hmo | $71 | 210% |
| Cigna | $71 - $249 | 210% |
| Great-West/Phcs | $71 - $249 | 210% |
| Health Net Pmg Hmo | $71 - $223 | 210% |
| Pacificare Hmo | $71 - $213 | 210% |
| Kaiser Northern | $121 | 359% |
| Pinnacle Claims Tpa/Bc | $142 - $317 | 421% |
| Western Growers Trust/Bc | $142 - $317 | 421% |
| Western Health Advantage | $178 | 528% |
| Health Net Smartcare Netw | $213 | 631% |
| Pacificare Ppo | $213 | 631% |
| Self Pay | $213 | 631% |
| Health Net Blue And Gold | $223 | 661% |
| Health Net Canopycare Hmo | $223 | 661% |
| Adventist Risk Management | $249 - $284 | 738% |
| First Health | $249 - $284 | 738% |
| Geha (Ccn) | $249 - $284 | 738% |
| Transwestern | $249 - $284 | 738% |
| Multiplan Inc Ppo | $277 | 821% |
| Private Healthcare System | $277 | 821% |
| Coastal Healthcare Admin | $302 - $320 | 895% |
| Salinas Valley Mem Hops | $302 | 895% |
| Calif Ironworkers Field | $308 - $317 | 913% |
| Carpenters H&W Trust | $308 - $317 | 913% |
| City Of Wats/Pinnacle Clm | $308 - $317 | 913% |
| Claims Management Wc | $308 - $317 | 913% |
| Delta Health Systems | $308 - $317 | 913% |
| Laborers Health & Welfare | $308 - $317 | 913% |
| Monterey Bay Pub Emp Trst | $308 - $317 | 913% |
| Operating Engineers | $308 - $317 | 913% |
| Robert Kennedy/Ccn | $308 - $317 | 913% |
| Sheet Metal Workers | $308 - $317 | 913% |
| State Compensation Fund | $308 - $317 | 913% |
| Teamsters Benefit Trust | $308 - $317 | 913% |
| Aaa | $356 | 1055% |
| Aarp | $356 | 1055% |
| Allstate | $356 | 1055% |
| Apwu Health Plan | $356 | 1055% |
| Bankers Life & Casualty | $356 | 1055% |
| Farmers Insurance | $356 | 1055% |
| Humana | $356 | 1055% |
| Miscellaneous Auto | $356 | 1055% |
| Miscellaneous Insurance | $356 | 1055% |
| North Calif Bakery Driver | $356 | 1055% |
| Physicians Mutual | $356 | 1055% |
| Prucare Pmg Hmo | $356 | 1055% |
| Prucare Pmg Pos | $356 | 1055% |
| State Farm Ins | $356 | 1055% |
| Sutter Health Plus | $356 | 1055% |
| United Administrative | $356 | 1055% |
| Wholesale Beer Distributo | $356 | 1055% |
| Zenith National Ins | $356 | 1055% |