CMS Price Transparency Data

Physical therapy (functional capacity test)

Facility: Adventist Health Clearlake

Billing Code: 97750 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97750
Insurance Median: $318
Cash Discount Price: $136
vs. Medicare Baseline: 9.43x Medicare

The contracted insurance negotiated median rate for a Physical therapy (functional capacity test) at Adventist Health Clearlake is $318. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $136. Compared to the federal Medicare reimbursement reference rate of $33.73, this hospital’s rate is 9.43x the Medicare baseline. Located in 15630 18Th Ave - Hwy 53, Clearlake, CA.

Cash / Self-Pay

$136

Average discount available for prompt cash payment at this facility.

Insurance Median

$318

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: $136 (403%)

Insurance Median: $318 (943%)

Cash: $136 (403% of Medicare)

Ins. Median: $318 (943% 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 943% of the Medicare baseline (a markup of 843%). 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
Bc Managed Mcal	$16	47%
Medi-Cal	$16	47%
Blue Shield Mcr Adv	$79	234%
Kaiser Mcr Adv	$79	234%
Tricare	$79	234%
Blue Cross Blue Shield	$83 - $543	246%
UnitedHealthcare	$87 - $315	258%
Ah Employee Health Plan - All Plans	$159	471%
Aetna	$282	836%
Western Growers- All Plans	$284	842%
First Health- All Plans	$302	895%
Healthnet- All Plans	$310	919%
Foundation- All Plans	$321	952%
Health Mgmt Network- All Plans	$321	952%
Humana	$321	952%
Phcs- All Plans	$321	952%
Blue Shield Epn - All Other Plans	$326	966%
Blue Shield Non-Epn	$333	987%
Cigna	$340	1008%
Interplan- All Plans	$340	1008%
Kaiser- All Other Plans	$340	1008%
Three Rivers Provider Network- All Plans	$340	1008%
Partnership Mcal - All Plans	$624	1850%

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 $136.
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 Clearlake 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.