CMS Price Transparency Data

Physical therapy (functional capacity test)

Facility: Shriners Hospitals for Children Northern Calif

Billing Code: 97750 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97750
Insurance Median: $37
Cash Discount Price: $287
vs. Medicare Baseline: 1.10x Medicare

The contracted insurance negotiated median rate for a Physical therapy (functional capacity test) at Shriners Hospitals for Children Northern Calif is $37. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $287. Compared to the federal Medicare reimbursement reference rate of $33.73, this hospital’s rate is 1.10x the Medicare baseline. Located in 2425 Stockton Boulevard, Sacramento, CA.

Cash / Self-Pay

$287

Average discount available for prompt cash payment at this facility.

Insurance Median

$37

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: $287 (851%)

Insurance Median: $37 (110%)

Cash: $287 (851% of Medicare)

Ins. Median: $37 (110% 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
Aetna	$16 - $51	47%
Ambetter / Centene	$16 - $41	47%
Blue Cross Blue Shield	$16 - $307	47%
Central California Alliance For Health	$16	47%
Health Plan Of San Joaquin	$16	47%
Kaiser Permanente	$16 - $100	47%
Molina Healthcare Of Ca	$16	47%
Partnership Healthplan Of Ca	$16	47%
Molina Healthcare Of Ms	$32	95%
Northbay Healthcare	$36	107%
Amerihealth Caritas Nc	$37	110%
Amerihealth Caritas Sc	$37	110%
Caresource Of Oh	$37	110%
Sutter Medical Foundation	$39	116%
Health Net Of Ca	$41	122%
Sana Benefits	$45 - $50	133%
Cigna	$130	385%
Providence Health Plan	$139	412%
UnitedHealthcare	$167 - $180	495%
Dignity Health	$233	691%

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 $287.
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 Shriners Hospitals for Children Northern Calif 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.