CMS Price Transparency Data

Physical therapy (functional capacity test)

Facility: Fairview Hospital

Billing Code: 97750 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97750
Insurance Median: $105
Cash Discount Price: $164
vs. Medicare Baseline: 3.11x Medicare

The contracted insurance negotiated median rate for a Physical therapy (functional capacity test) at Fairview Hospital is $105. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $164. Compared to the federal Medicare reimbursement reference rate of $33.73, this hospital’s rate is 3.11x the Medicare baseline. Located in 18101 Lorain Avenue, Cleveland, OH.

Cash / Self-Pay

$164

Average discount available for prompt cash payment at this facility.

Insurance Median

$105

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: $164 (486%)

Insurance Median: $105 (311%)

Cash: $164 (486% of Medicare)

Ins. Median: $105 (311% 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 311% of the Medicare baseline (a markup of 211%). 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
Aetna	$43 - $252	127%
Devoted Health	$43	127%
Humana	$43 - $214	127%
Mmo	$43 - $149	127%
Summacare	$43 - $96	127%
The Health Plan	$43 - $151	127%
United	$43 - $239	127%
UnitedHealthcare	$43 - $156	127%
Upmc	$43 - $151	127%
Valor	$43	127%
Cigna	$44 - $202	130%
Perennial Health	$46	136%
Blue Cross Blue Shield	$47 - $162	139%
Paramount	$75	222%
Buckeye	$76	225%
Molina	$76	225%
Oscar	$76 - $97	225%
Zing Health	$76	225%
United Bh	$77	228%
Caresource	$78	231%
Amerihealth	$80	237%
Cc Ehp	$101 - $102	299%
Aultcare	$108	320%
Amish Community Aid Plan	$113 - $126	335%
Ohcp	$122	362%
Omas	$126	374%
Ohio Healthy	$136	403%
Healthsmart	$139	412%
Php	$151	448%
Phphi	$151	448%
Gms	$176	522%
Medical Benefit Corp	$176	522%
Quality Care Partners	$176	522%
Consociate Health	$189	560%
Frontpath	$227	673%
Managed Care Services	$227	673%
Multiplan	$227	673%
Tertiary Care Network	$227	673%
Three Rivers	$227	673%

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 $164.
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 Fairview Hospital 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.