CMS Price Transparency Data

Physical therapy (functional capacity test)

Facility: Loma Linda University Children's Hospital

Billing Code: 97750 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97750
Insurance Median: $172
Cash Discount Price: $113
vs. Medicare Baseline: 5.10x Medicare

The contracted insurance negotiated median rate for a Physical therapy (functional capacity test) at Loma Linda University Children's Hospital is $172. 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 5.10x the Medicare baseline. Located in 11234 Anderson Street Suite A, Loma Linda, CA.

Cash / Self-Pay

$113

Average discount available for prompt cash payment at this facility.

Insurance Median

$172

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: $172 (510%)

Cash: $113 (335% of Medicare)

Ins. Median: $172 (510% 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 510% of the Medicare baseline (a markup of 410%). 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
Inland Empire Health Plan (Iehp)	$19	56%
Kaiser Foundation Hospitals	$22 - $168	65%
Adventist Health	$50 - $103	148%
Lluh Dept Of Risk Management	$60	178%
Epic Health Plan	$101	299%
Alpha Care Medical Group	$139 - $214	412%
Global Benefits Group	$151	448%
Temecula Valley Physicians Medical Group	$151	448%
Trivalley Medical Group	$151	448%
Cigna	$161 - $186	477%
Networks By Design	$164	486%
Aetna	$165	489%
Molina Healthcare Of Ca	$176	522%
Multiplan	$202	599%
UnitedHealthcare	$206 - $417	611%
Dignity Health	$214	634%
Galaxy Health	$214	634%
Prime Health Services	$214	634%
Vantage Medical Group	$214	634%
Blue Shield Of California	$279 - $421	827%
Blue Cross Blue Shield	$457	1355%

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 Loma Linda University Children's 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.