CMS Price Transparency Data

Physical therapy (functional capacity test)

Facility: Riverside Community Hospital

Billing Code: 97750 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97750
Insurance Median: $36
Cash Discount Price: $269
vs. Medicare Baseline: 1.07x Medicare

The contracted insurance negotiated median rate for a Physical therapy (functional capacity test) at Riverside Community Hospital is $36. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $269. Compared to the federal Medicare reimbursement reference rate of $33.73, this hospital’s rate is 1.07x the Medicare baseline. Located in 4445 Magnolia Avenue, Riverside, CA.

Cash / Self-Pay

$269

Average discount available for prompt cash payment at this facility.

Insurance Median

$36

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: $269 (798%)

Insurance Median: $36 (107%)

Cash: $269 (798% of Medicare)

Ins. Median: $36 (107% 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
La Care Health	$16	47%
Molina	$16	47%
Brand New Day	$18 - $36	53%
Inland Empire Health Plan	$24 - $61	71%
Bristol Hospice	$25 - $29	74%
Aetna	$31 - $48	92%
Alignment Health Plan	$31 - $36	92%
Blue Cross Blue Shield	$31 - $36	92%
Central Health Plan	$31 - $36	92%
Clever Care Of Golden State	$31 - $36	92%
Easy Choice Health Plan	$31 - $36	92%
Heritage Provider Network	$31 - $49	92%
Humana	$31 - $36	92%
Redlands Community Hospital	$31 - $36	92%
Riverside Medical Clinic	$31 - $43	92%
Riverside Physician	$31 - $36	92%
Scan Health Plan	$31 - $36	92%
Triwest Healthcare Alliance	$31 - $36	92%
UnitedHealthcare	$31 - $36	92%
Care1St Health Plan	$32 - $36	95%
United	$32 - $71	95%
Blue Shield	$33 - $81	98%
Health Net	$35 - $60	104%
Corvel Corporation	$37 - $42	110%
Healthsmart	$37 - $215	110%
Next	$37 - $215	110%
Medcare Partners	$40	119%
Bright Health	$106	314%
First Health	$118 - $242	350%
American Health System	$121	359%
Multiplan	$215 - $228	637%

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 $269.
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 Riverside Community 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.