CMS Price Transparency Data

Physical therapy (therapeutic exercise)

Facility: Valley Presbyterian Hospital

Billing Code: 97110 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97110
Insurance Median: $129
Cash Discount Price: $211
vs. Medicare Baseline: 4.44x Medicare

The contracted insurance negotiated median rate for a Physical therapy (therapeutic exercise) at Valley Presbyterian Hospital is $129. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $211. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 4.44x the Medicare baseline. Located in 15107 Vanowen St, Van Nuys, CA.

Cash / Self-Pay

$211

Average discount available for prompt cash payment at this facility.

Insurance Median

$129

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$29.06

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $29.06 (100%)

Cash / Self-Pay: $211 (726%)

Insurance Median: $129 (444%)

Cash: $211 (726% of Medicare)

Ins. Median: $129 (444% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $29.06 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 444% of the Medicare baseline (a markup of 344%). 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 Shield Senior	$31	107%
Aetna	$32 - $127	110%
Blue Cross Blue Shield	$32 - $143	110%
Health Net Senior	$32	110%
La Care Covered California	$32	110%
Medicare (plans)	$32 - $34	110%
Blue Shield Promise Medi-Cal	$42 - $56	145%
Ambetter / Centene	$45	155%
Heritage Provider Network (Regal & Lakeside)	$50	172%
Health Net	$63	217%
Cigna	$90 - $120	310%
La Care Medi-Cal	$101 - $134	348%
Phcs	$101 - $134	348%
Coventry Health Care (Ccn)	$118 - $156	406%
UnitedHealthcare	$120 - $253	413%
Beech Street	$126 - $167	434%
Multiplan	$151 - $201	520%
Blue Shield Ifp	$261	898%
Blue Shield	$299	1029%

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 $211.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 97110.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Valley Presbyterian Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 97110.
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.