CMS Price Transparency Data

Physical therapy (functional capacity test)

Facility: Cambridge Health Alliance

Billing Code: 97750 (CPT)

Factual Cost Summary (Answer Capsule)

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

The contracted insurance negotiated median rate for a Physical therapy (functional capacity test) at Cambridge Health Alliance is $95. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $95. Compared to the federal Medicare reimbursement reference rate of $33.73, this hospital’s rate is 2.82x the Medicare baseline. Located in 1493 Cambridge Street, Cambridge, MA.

Cash / Self-Pay

$95

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: $95 (282%)

Insurance Median: $95 (282%)

Cash: $95 (282% 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
Wc [90001]	$34	101%
Wellpoint [50012]	$59	175%
Mass General Brigham [50021]	$60	178%
Other Tufts Health Public Plan [75002]	$63	187%
Multiplan [50010]	$65	193%
Aetna	$83 - $95	246%
Altus Dental [99011]	$95	282%
Beacon Health Strategies [50002]	$95	282%
Blue Cross Blue Shield	$95	282%
Cbhc Uninsured Crisis Alt Payer [70097]	$95	282%
Cbhc Uninsured Crisis [70096]	$95	282%
Celticare [50004]	$95	282%
Cigna	$95 - $184	282%
Commonwealth Care Alliance Dental [99004]	$95	282%
Coverage Discovery [90004]	$95	282%
Delta Dental Of Ma [99007]	$95	282%
Dominion National Dental [99012]	$95	282%
Dph Tb Payor [85004]	$95	282%
Esp Dental [99003]	$95	282%
Eyemed Alt Payor [13001]	$95	282%
First Health [50007]	$95	282%
Global Medical Management [50024]	$95	282%
Government Employee Health Association [50023]	$95	282%
Guardian Dental [99013]	$95	282%
Health Safety Net Dental [99002]	$95	282%
Humana	$95	282%
Ma Laborers Health And Welfare Fund [50022]	$95	282%
Magellan Health Services [65098]	$95	282%
Mass Health Dental [99001]	$95	282%
Medical Mutual Of Ohio [50019]	$95	282%
Medicare (plans)	$95	282%
Metlife Dental [99008]	$95	282%
Modern Assistance Program [30098]	$95	282%
Mva [90002]	$95	282%
Neighborhood Health Plan [50011]	$95	282%
Other Bh Payor [50014]	$95	282%
Other Commercial Payor [50015]	$95	282%
Other Dental Payor [99014]	$95	282%
Other Dual Eligible Payer [65004]	$95	282%
Other Gov'T Alt [85006]	$95	282%
Other Vision Payor [50013]	$95	282%
Ri Neighborhood Health Plan [50017]	$95	282%
Tricare	$95	282%
Tufts Health Plan [30001]	$106 - $123	314%
Aarp [40001]	$188	557%
Oxford Health [40004]	$188	557%
United Medical Resource [40005]	$188	557%
UnitedHealthcare	$188 - $312	557%
Health Plans Inc [20002]	$312	925%
Hphc [20001]	$312	925%

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 $95.
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 Cambridge Health Alliance 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.