CMS Price Transparency Data

Physical therapy (functional capacity test)

Facility: El Centro Regional Medical Center

Billing Code: 97750 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97750
Insurance Median: $105
Cash Discount Price: $113
vs. Medicare Baseline: 3.11x Medicare

The contracted insurance negotiated median rate for a Physical therapy (functional capacity test) at El Centro Regional Medical Center is $105. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $113. Compared to the federal Medicare reimbursement reference rate of $33.73, this hospital’s rate is 3.11x the Medicare baseline. Located in 1415 Ross Avenue, El Centro, CA.

Cash / Self-Pay

$113

Average discount available for prompt cash payment at this facility.

Insurance Median

$105

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: $113 (335%)

Insurance Median: $105 (311%)

Cash: $113 (335% of Medicare)

Ins. Median: $105 (311% 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 311% of the Medicare baseline (a markup of 211%). 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	$36 - $254	107%
Brand New Day Comm - All Other Plans	$36	107%
Brand New Day Mcr	$36	107%
Healthnet Mcr Adv	$36	107%
Molina Mcr Adv	$36	107%
Scp Managed Care - All Plans	$36	107%
Tricare	$36	107%
UnitedHealthcare	$36 - $81	107%
Easy Choice Mcr Adv-All Plans	$39	116%
Healthnet Hmo	$44	130%
Cdcr Correctional-All Plans	$46	136%
Aetna	$71	210%
Pacificare-All Plans	$100	296%
Mulitplan Primary - All Other Plans	$110	326%
Cigna	$122	362%
Multiplan Comp	$130	385%
Trident - All Plans	$138	409%
Healthnet Comm-All Other Plans	$146	433%
Humana	$151	448%
Ahccs/Medi-Cal Misc - All Plans	$162	480%
Brand New Day Mcal	$162	480%
Medi-Cal	$162	480%
Molina Exchange - All Other Plans	$162	480%
Ambetter / Centene	$167	495%
Molina Mcal	$178	528%
Blue Shield-All Plans	$338	1002%

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 $113.
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 El Centro Regional 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.