CMS Price Transparency Data

Physical therapy (functional capacity test)

Facility: Adventist Health Tillamook

Billing Code: 97750 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97750
Insurance Median: $86
Cash Discount Price: $50
vs. Medicare Baseline: 2.55x Medicare

The contracted insurance negotiated median rate for a Physical therapy (functional capacity test) at Adventist Health Tillamook is $86. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $50. Compared to the federal Medicare reimbursement reference rate of $33.73, this hospital’s rate is 2.55x the Medicare baseline. Located in 1000 Third Street, Tillamook, OR.

Cash / Self-Pay

$50

Average discount available for prompt cash payment at this facility.

Insurance Median

$86

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: $50 (148%)

Insurance Median: $86 (255%)

Cash: $50 (148% of Medicare)

Ins. Median: $86 (255% 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 255% of the Medicare baseline (a markup of 155%). 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
Blue Cross Blue Shield	$43 - $80	127%
Medicare (plans)	$43	127%
Moda Health Plan - All Plans	$43	127%
Hvhs Mcare - All Plans	$44	130%
Sterling Life - All Plans	$45	133%
Devoted Health	$47	139%
Aetna	$48 - $86	142%
Lifewise - All Plans	$83	246%
Ah Employee Health Plan - All Plans	$86	255%
First Choice Health- All Plans	$86	255%
Health Net - All Plans	$86	255%
Cigna	$87	258%
Phcs Preferred - All Plans	$87	258%
UnitedHealthcare	$87	258%
Pacificsource - All Plans	$88	261%
Ods Health Plan - All Other Plans	$89	264%
Providence Preferred - All Plans	$90	267%
Workers Comp	$92	273%

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 $50.
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 Tillamook 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.