CMS Price Transparency Data

Physical therapy (therapeutic exercise)

Facility: Adventist Health Sierra Vista

Billing Code: 97110 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97110
Insurance Median: $347
Cash Discount Price: $40
vs. Medicare Baseline: 11.94x Medicare

The contracted insurance negotiated median rate for a Physical therapy (therapeutic exercise) at Adventist Health Sierra Vista is $347. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $40. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 11.94x the Medicare baseline. Located in 1010 Murray St, San Luis Obispo, CA.

Cash / Self-Pay

$40

Average discount available for prompt cash payment at this facility.

Insurance Median

$347

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: $40 (138%)

Insurance Median: $347 (1194%)

Cash: $40 (138% of Medicare)

Ins. Median: $347 (1194% 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 1194% of the Medicare baseline (a markup of 1094%). 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	$31 - $468	107%
Cencal Mcr Adv - All Other Plans	$31	107%
Tricare	$31	107%
UnitedHealthcare	$31 - $431	107%
Cfmg-Ca Forensic Med Grp Op/Profee Only-All Plans	$40	138%
Ah Employee Health Plan - All Plans	$56	193%
Hpn-Heritage Prov Ntwrk-All Plans	$148 - $168	509%
Nbd-Ntwrks By Design Exclus-All Other Plans	$252 - $285	867%
Nbd-Ntwrks By Design Non-Exclus	$252 - $285	867%
Blue Shield Epn	$273	939%
Blue Shield Hmo/Pos	$344	1184%
Blue Shield Epo/Ppo-All Other Plans	$373	1284%
Medi-Cal	$436 - $493	1500%
Cencal Mcal	$497 - $562	1710%
Blue Shield Promise Mcal	$524 - $593	1803%
Ccah-Centrl Ca Allince Mcal-All Plans	$567 - $641	1951%
Coalinga-All Plans	$567 - $641	1951%

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 $40.
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 Adventist Health Sierra Vista 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.