CMS Price Transparency Data

Physical therapy (functional capacity test)

Facility: Clarion Hospital

Billing Code: 97750 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97750
Insurance Median: $34
Cash Discount Price: $48
vs. Medicare Baseline: 1.01x Medicare

The contracted insurance negotiated median rate for a Physical therapy (functional capacity test) at Clarion Hospital is $34. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $48. Compared to the federal Medicare reimbursement reference rate of $33.73, this hospital’s rate is 1.01x the Medicare baseline. Located in One Hospital Drive, Clarion, PA.

Cash / Self-Pay

$48

Average discount available for prompt cash payment at this facility.

Insurance Median

$34

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: $48 (142%)

Insurance Median: $34 (101%)

Cash: $48 (142% of Medicare)

Ins. Median: $34 (101% 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.

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
Upmc	$12 - $53	36%
Highmark	$29 - $53	86%
Highmark - Ind.& Managed Care	$29 - $72	86%
Martin'S Point - Usfhp	$30 - $32	89%
Amerihealth	$32	95%
Cigna	$32 - $43	95%
Gateway	$32 - $34	95%
Highmark Community Blue	$32	95%
Medicare (plans)	$32	95%
Tricare	$32	95%
UnitedHealthcare	$32	95%
Aetna	$33 - $77	98%
Devoted Health Plan	$34	101%
Geisinger	$34	101%
Pa Health & Wellness	$34	101%
The Health Plan	$34 - $75	101%
American Health Plan	$35	104%
Peak Health	$60 - $75	178%
Devon	$64	190%
Workers Comp	$69	205%

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 $48.
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 Clarion 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.