CMS Price Transparency Data

Physical therapy (functional capacity test)

Facility: Adventist Health Tulare

Billing Code: 97750 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97750
Insurance Median: $52
Cash Discount Price: $36
vs. Medicare Baseline: 1.54x Medicare

The contracted insurance negotiated median rate for a Physical therapy (functional capacity test) at Adventist Health Tulare is $52. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $36. Compared to the federal Medicare reimbursement reference rate of $33.73, this hospital’s rate is 1.54x the Medicare baseline. Located in 869 North Cherry Street, Tulare, CA.

Cash / Self-Pay

$36

Average discount available for prompt cash payment at this facility.

Insurance Median

$52

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: $36 (107%)

Insurance Median: $52 (154%)

Cash: $36 (107% of Medicare)

Ins. Median: $52 (154% 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.

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
Medi-Cal	$16	47%
Dignity Mcal Op Only	$18	53%
Independence Op Only - All Plans	$18	53%
Blue Cross Blue Shield	$19 - $410	56%
Ccipa Medi-Cal - All Plans	$21	62%
Healthnet Medi-Cal	$22	65%
Blue Shield Mcare	$36	107%
Dignity Mcr Op Only - All Other Plans	$36	107%
Fhcn Pace Mcr Adv - All Plans	$36	107%
Medicare (plans)	$36	107%
Prime Health - All Plans	$36	107%
Tricare	$36	107%
UnitedHealthcare	$36 - $602	107%
Cal Forensic Med Grp - All Plans	$46	136%
Prison Hlthcre - All Plans	$46	136%
Bright Health - All Plans	$52	154%
Ah Employee Health Plan - All Plans	$64	190%
Incentive Hlth - All Plans	$64	190%
Cigna	$88	261%
Western Growers - All Plans	$89	264%
Healthnet Hmo/Ppo - All Other Plans	$95	282%
Aetna	$111	329%
Network By Design-All Plans	$124	368%
Hs Interplan-All Plans	$127	377%
Multiplan - All Plans	$162	480%
Blue Shield Epn	$256	759%
Blue Shield-All Other Plans	$356	1055%

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 $36.
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 Tulare 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.