CMS Price Transparency Data

Physical therapy (functional capacity test)

Facility: Stanford Health Care

Billing Code: 97750 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97750
Insurance Median: $95
Cash Discount Price: $188
vs. Medicare Baseline: 2.82x Medicare

The contracted insurance negotiated median rate for a Physical therapy (functional capacity test) at Stanford Health Care is $95. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $188. Compared to the federal Medicare reimbursement reference rate of $33.73, this hospital’s rate is 2.82x the Medicare baseline. Located in 300 Pasteur Drive, Stanford, CA.

Cash / Self-Pay

$188

Average discount available for prompt cash payment at this facility.

Insurance Median

$95

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: $188 (557%)

Insurance Median: $95 (282%)

Cash: $188 (557% of Medicare)

Ins. Median: $95 (282% 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 282% of the Medicare baseline (a markup of 182%). 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 Of San Mateo [31200]	$20	59%
Healthnet	$43	127%
Cigna	$57 - $66	169%
Aetna	$76	225%
Beech St [10600]	$94	279%
Claritev [13400]	$94	279%
Kaiser Northern Ca [12900]	$94	279%
Private Healthcare Systems (Phcs) [14200]	$94	279%
Healthnet Alt Payer [912100000]	$95	282%
Healthnet [12100]	$95	282%
Blue Card (Out Of State) [40000]	$100	296%
Blue Cross Blue Shield	$100 - $144	296%
Shca Comm Intel [20300000]	$100	296%
American Specialty Health Plan Alt Payer [971000000]	$144	427%
Blue Card (Out Of State) - Blue Shield [40200]	$144	427%
Blue Shield Alt Payer [970000000]	$144	427%
Blue Shield [70000]	$144	427%
Psych Blue Shield Alt Payer [970000100]	$144	427%
UnitedHealthcare	$147	436%

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 $188.
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 Stanford Health Care 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.