CMS Price Transparency Data

Physical therapy (functional capacity test)

Facility: Adventist Health Portland

Billing Code: 97750 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97750
Insurance Median: $128
Cash Discount Price: $72
vs. Medicare Baseline: 3.79x Medicare

The contracted insurance negotiated median rate for a Physical therapy (functional capacity test) at Adventist Health Portland is $128. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $72. Compared to the federal Medicare reimbursement reference rate of $33.73, this hospital’s rate is 3.79x the Medicare baseline. Located in 10123 Se Market Street, Portland, OR.

Cash / Self-Pay

$72

Average discount available for prompt cash payment at this facility.

Insurance Median

$128

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: $72 (213%)

Insurance Median: $128 (379%)

Cash: $72 (213% of Medicare)

Ins. Median: $128 (379% 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 379% of the Medicare baseline (a markup of 279%). 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
Ods - All Plans	$29	86%
Care Oregon - All Plans	$31	92%
Kaiser Mcr Adv	$36	107%
Humana	$37 - $38	110%
Moda Mcr Adv	$38	113%
UnitedHealthcare	$38 - $135	113%
Healthnet Mcr Adv	$41	122%
Ah Employee Health Plan - All Plans	$65	193%
Moda Conn Oebb/Syn Pebb	$72	213%
Workers Comp	$78	231%
Moda Affinity - All Other Plans	$83	246%
Kaiser - All Other Plans	$94	279%
Regence Ohsu Plus	$99	294%
Regence - All Other Plans	$110	326%
Bc Premera First - All Plans	$112	332%
Moda Select	$112	332%
Moda Connexus	$127	377%
Healthnet Hmo/Pos - All Other Plans	$128	379%
Healthnet Epo/Pos/Ppo	$129	382%
Moda Synergy	$135	400%
Worldventure - All Plans	$135	400%
Providence Hp - All Plans	$146	433%
Regence Preferred Mcr Adv	$147	436%
Pacific Source Comm - All Plans	$148	439%
Cigna	$152	451%
First Choice - All Plans	$156	462%
Multiplan - All Plans	$169	501%
Phcs - All Plans	$169	501%
Regence Mcr Adv	$171	507%
Aetna	$176	522%
First Health-Coventry - All Plans	$180	534%
National Provider Network - All Plans	$198	587%
Health Payors Organization Ltd- All Plans	$202	599%
Healthcare Resources - All Plans	$205	608%
Moda Ohsu Ppo/Epo/Hmc	$405	1201%

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 $72.
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 Portland 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.