CMS Price Transparency Data
Physical therapy (functional capacity test)
Facility: Coastal Communities Hospital
Billing Code: 97750 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 97750
- Insurance Median: $43
- Cash Discount Price: $88
- vs. Medicare Baseline: 1.27x Medicare
The contracted insurance negotiated median rate for a Physical therapy (functional capacity test) at Coastal Communities Hospital is $43. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $88. Compared to the federal Medicare reimbursement reference rate of $33.73, this hospital’s rate is 1.27x the Medicare baseline. Located in 2701 S Bristol St, Santa Ana, CA.
Cash / Self-Pay
$88
Average discount available for prompt cash payment at this facility.
Insurance Median
$43
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: $88 (261%)
Insurance Median: $43 (127%)
Cash: $88 (261% of Medicare)
Ins. Median: $43 (127% 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
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Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Kpc Healthcare Inc | $14 - $47 | 42% |
| Altamed Mcal Hmo (Ancillary) | $16 | 47% |
| Healthcare Partners | $16 | 47% |
| Hollywood Presbyterian | $16 - $38 | 47% |
| Kaiser | $16 - $54 | 47% |
| Medi-Cal Hmo/Non Contract | $16 | 47% |
| Medicaid / KanCare | $16 | 47% |
| Altamed Health Services | $23 - $38 | 68% |
| Caloptima | $23 - $38 | 68% |
| Choc Health Alliance | $23 | 68% |
| County Of Orange | $23 | 68% |
| Family Choice | $23 | 68% |
| Heritage Provider Network | $23 - $53 | 68% |
| Prospect Health Plan | $23 - $56 | 68% |
| Ihhi Reciprocity | $26 | 77% |
| Champus | $36 | 107% |
| Blue Shield | $38 - $143 | 113% |
| Central Health Plan Of California | $38 | 113% |
| Champion Health Plan | $38 | 113% |
| Choice Physicians Network | $38 | 113% |
| Citizens Choice Health Plan | $38 | 113% |
| Clever Care Health Plan | $38 | 113% |
| Easy Choice Health Plan | $38 | 113% |
| For Your Benefit | $38 | 113% |
| Health Net | $38 - $65 | 113% |
| Healthcare Partners Sr Hmo | $38 | 113% |
| Heritage | $38 | 113% |
| Humana | $38 | 113% |
| Imperial Health Plan Of Ca | $38 | 113% |
| Innovative Integrated Health | $38 | 113% |
| Medcare Partners | $38 | 113% |
| Monarch | $38 - $167 | 113% |
| Onecare | $38 | 113% |
| Onecare Connect | $38 | 113% |
| Other Senior Non Contract | $38 | 113% |
| Scan Health Plan | $38 | 113% |
| Self Pay Ab774/Cbo Use Only | $38 | 113% |
| UnitedHealthcare | $38 - $220 | 113% |
| Us Dept Of Labor | $38 | 113% |
| Us Federal Marshall/Department Of Immigration | $38 | 113% |
| Velocity Provider Network Sr | $38 | 113% |
| Verda Health Plan Sr | $38 | 113% |
| Veterans Administration | $38 | 113% |
| Victim Of Violent Crime | $38 | 113% |
| Victoria Hospice | $38 | 113% |
| Coventry Auto Network | $41 | 122% |
| Interplan | $41 - $66 | 122% |
| Prime Health Srvs/Wc | $41 | 122% |
| Brand New Day | $42 | 125% |
| Coventry Wc | $43 | 127% |
| Prime Health Srvs | $43 - $70 | 127% |
| Multiplan | $45 - $62 | 133% |
| Three Rivers | $45 | 133% |
| First Health | $46 | 136% |
| Velocity National Provider Network Wc | $46 | 136% |
| Workers Comp State Of California | $46 | 136% |
| County Of Orange/Custody/Advanced Medmgt | $47 | 139% |
| Veterans Evaluation Services | $47 | 139% |
| Aetna | $48 | 142% |
| Magellan | $53 | 157% |
| Staywell/Island Home Ins | $53 | 157% |
| Cigna | $57 - $315 | 169% |
| Networks By Design | $62 | 184% |
| Networks By Design Wc | $62 | 184% |
| Healthsmart | $66 | 196% |
| Prime Health | $66 | 196% |
| Three Rivers Network | $66 | 196% |
| Velocity National Provider Network Ppo | $66 | 196% |
| Pnoa-Provider Network Of America | $70 | 208% |
| Prime Health Srvs/Network | $75 | 222% |
| Lucet Behavioral Health Sr | $88 | 261% |
| Managed Health Network | $88 | 261% |
| Other Insurance Loa | $88 | 261% |
| Other Non Contracted Plans | $88 | 261% |
| Private Pay | $88 | 261% |
| Us Behavioral Health Plan | $88 | 261% |
| Vitas Hospice | $88 | 261% |
| Monarch Health Plan | $179 | 531% |