CMS Price Transparency Data

Physical therapy (neuromuscular re-education)

Facility: Adventist Health Sierra Vista

Billing Code: 97112 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97112
Insurance Median: $302
Cash Discount Price: $44
vs. Medicare Baseline: 9.23x Medicare

The contracted insurance negotiated median rate for a Physical therapy (neuromuscular re-education) at Adventist Health Sierra Vista is $302. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $44. Compared to the federal Medicare reimbursement reference rate of $32.73, this hospital’s rate is 9.23x the Medicare baseline. Located in 1010 Murray St, San Luis Obispo, CA.

Cash / Self-Pay

$44

Average discount available for prompt cash payment at this facility.

Insurance Median

$302

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$32.73

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $32.73 (100%)

Cash / Self-Pay: $44 (134%)

Insurance Median: $302 (923%)

Cash: $44 (134% of Medicare)

Ins. Median: $302 (923% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $32.73 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 923% of the Medicare baseline (a markup of 823%). 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
Aetna	$35 - $468	107%
Cencal Mcr Adv - All Other Plans	$35	107%
Tricare	$35	107%
UnitedHealthcare	$35 - $431	107%
Cfmg-Ca Forensic Med Grp Op/Profee Only-All Plans	$46	141%
Ah Employee Health Plan - All Plans	$63	192%
Hpn-Heritage Prov Ntwrk-All Plans	$167	510%
Blue Shield Epn	$273	834%
Nbd-Ntwrks By Design Exclus-All Other Plans	$283	865%
Nbd-Ntwrks By Design Non-Exclus	$283	865%
Blue Shield Hmo/Pos	$344	1051%
Blue Shield Epo/Ppo-All Other Plans	$373	1140%
Medi-Cal	$490	1497%
Cencal Mcal	$559	1708%
Blue Shield Promise Mcal	$589	1800%
Ccah-Centrl Ca Allince Mcal-All Plans	$637	1946%
Coalinga-All Plans	$637	1946%

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 $44.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 97112.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Adventist Health Sierra Vista is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 97112.
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.