CMS Price Transparency Data

Physical therapy (functional capacity test)

Facility: San Dimas Community Hospital

Billing Code: 97750 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97750
Insurance Median: $38
Cash Discount Price: $37
vs. Medicare Baseline: 1.13x Medicare

The contracted insurance negotiated median rate for a Physical therapy (functional capacity test) at San Dimas Community Hospital is $38. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $37. Compared to the federal Medicare reimbursement reference rate of $33.73, this hospital’s rate is 1.13x the Medicare baseline. Located in 1350 W Covina Blvd, San Dimas, CA.

Cash / Self-Pay

$37

Average discount available for prompt cash payment at this facility.

Insurance Median

$38

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: $37 (110%)

Insurance Median: $38 (113%)

Cash: $37 (110% of Medicare)

Ins. Median: $38 (113% 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
Aids Healthcare Foundation	$16 - $38	47%
Blue Shield Of Promise	$16	47%
Heritage Provider Network Inc	$16 - $49	47%
La Care Health Plan	$16 - $38	47%
Molina Healthcare	$16 - $38	47%
Traditional Medi-Cal	$16	47%
Blue Cross Blue Shield	$17 - $263	50%
Health Net Of Ca	$18 - $55	53%
Rios	$36	107%
Blue Shield Of Ca	$38 - $57	113%
Brand New Day	$38 - $56	113%
Central Health Plan	$38	113%
Choice Physicians Network	$38	113%
Citrus Valley Physicians Group	$38	113%
Elite Health Plan	$38	113%
Health Excel Inc	$38	113%
Medicare (plans)	$38	113%
Patient Choice Health Plan	$38	113%
Primecare Medical Network	$38 - $49	113%
Renal Payer Solutions	$38	113%
Tricare	$38	113%
UnitedHealthcare	$38 - $49	113%
Imperial Health Plan Inc	$40	119%
Aetna	$48	142%
Ca Foundation For Medical Care	$50	148%
Worker Comp	$50	148%
Employer Direct Healthcare	$53	157%

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 $37.
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 San Dimas 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.