CMS Price Transparency Data

Physical therapy (functional capacity test)

Facility: Clarinda Regional Health Center

Billing Code: 97750 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97750
Insurance Median: $85
Cash Discount Price: $96
vs. Medicare Baseline: 2.52x Medicare

The contracted insurance negotiated median rate for a Physical therapy (functional capacity test) at Clarinda Regional Health Center is $85. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $96. Compared to the federal Medicare reimbursement reference rate of $33.73, this hospital’s rate is 2.52x the Medicare baseline. Located in 220 Essie Davison Drive, Clarinda, IA.

Cash / Self-Pay

$96

Average discount available for prompt cash payment at this facility.

Insurance Median

$85

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: $96 (285%)

Insurance Median: $85 (252%)

Cash: $96 (285% of Medicare)

Ins. Median: $85 (252% 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 252% of the Medicare baseline (a markup of 152%). 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
Ambetter / Centene	$78 - $84	231%
Molina Mcr Adv-All Plans	$78	231%
UnitedHealthcare	$78 - $154	231%
Blue Cross Blue Shield	$79 - $130	234%
Ia Total Care Mcaid-All Plans	$85	252%
Geha-All Plans	$151	448%
Coventry Health-All Other Plans	$152	451%
Midlands Choice-All Plans	$154	457%
Multiplan-All Plans	$154	457%
Amerigroup Ia Mcaid-All Plans	$162	480%

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 $96.
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 Clarinda Regional Health Center 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.