CMS Price Transparency Data

Physical therapy (functional capacity test)

Facility: Grossmont Hospital

Billing Code: 97750 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97750
Insurance Median: $114
Cash Discount Price: $135
vs. Medicare Baseline: 3.38x Medicare

The contracted insurance negotiated median rate for a Physical therapy (functional capacity test) at Grossmont Hospital is $114. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $135. Compared to the federal Medicare reimbursement reference rate of $33.73, this hospital’s rate is 3.38x the Medicare baseline. Located in 5555 Grossmont Center Drive Box 58, La Mesa, CA.

Cash / Self-Pay

$135

Average discount available for prompt cash payment at this facility.

Insurance Median

$114

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: $135 (400%)

Insurance Median: $114 (338%)

Cash: $135 (400% of Medicare)

Ins. Median: $114 (338% 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 338% of the Medicare baseline (a markup of 238%). 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
Epic Americas	$7 - $144	21%
Molina	$25 - $144	74%
Allianz Global Assistance	$27 - $124	80%
Health Net	$27 - $3,637	80%
UnitedHealthcare	$50 - $144	148%
Aetna	$53 - $148	157%
Medicare (plans)	$53 - $135	157%
California Health And Wellness	$55 - $112	163%
Blue Shield	$61 - $3,637	181%
Cigna	$61 - $144	181%
Blue Cross Blue Shield	$70 - $126	208%
Interplan	$71 - $90	210%
Indian Health Council	$86 - $126	255%
San Diego Pace	$86	255%
County Medical Services	$90 - $144	267%
Kaiser	$99 - $115	294%
Managed Health Network	$112	332%
Community Health Group	$115 - $135	341%
Medi-Cal	$115 - $148	341%
Multiplan	$126	374%
Humana	$128 - $144	379%

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 $135.
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 Grossmont 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.