CMS Price Transparency Data

Physical therapy (functional capacity test)

Facility: Sanford Clear Lake Medical Center

Billing Code: 97750 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97750
Insurance Median: $89
Cash Discount Price: $86
vs. Medicare Baseline: 2.64x Medicare

The contracted insurance negotiated median rate for a Physical therapy (functional capacity test) at Sanford Clear Lake Medical Center is $89. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $86. Compared to the federal Medicare reimbursement reference rate of $33.73, this hospital’s rate is 2.64x the Medicare baseline. Located in 701 Third Avenue South, Clear Lake, SD.

Cash / Self-Pay

$86

Average discount available for prompt cash payment at this facility.

Insurance Median

$89

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: $86 (255%)

Insurance Median: $89 (264%)

Cash: $86 (255% of Medicare)

Ins. Median: $89 (264% 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 264% of the Medicare baseline (a markup of 164%). 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
Sanford Health Plan Align	$55	163%
Security Health Plan	$59	175%
Aetna	$60 - $94	178%
Health Partners	$60 - $81	178%
Medicare (plans)	$60	178%
Ucare	$60 - $95	178%
UnitedHealthcare	$60 - $90	178%
Wellmark Sd	$60	178%
Primewest	$61	181%
Sanford Health Plan	$75 - $100	222%
Blue Cross Blue Shield	$88 - $100	261%
Medica	$89 - $95	264%
Wellmark	$93 - $94	276%
Cigna	$97	288%
First Choice Health Network	$97	288%
Healthez	$97	288%
Multiplan	$97	288%

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 $86.
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 Sanford Clear Lake Medical Center 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.