Signature Cross-Insurance Cost Matrix • CPT 97110

Physical Therapy — Therapeutic Exercise (Per 15-Min Unit): Cost Across Insurances

Complete cell-by-cell comparison across Self-Pay Cash, Original Medicare, 6 Major California Commercial Payers (Anthem, Blue Shield, UnitedHealthcare, Aetna, Cigna, Kaiser Permanente), and Medi-Cal — with every cell labeled with its official data source and effective date.

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1. Published Prices(Cash & Medicare)2. Plan-Adjusted(Payer MRF Rate)3. Verified Price(Real-Time 270/271 Check)

Accuracy Level — Tier 1 Published Prices: You are currently viewing general published hospital cash prices, Medicare baselines, and multi-payer ranges. Add your insurance card to unlock Tier 2 plan pricing and Tier 3 verified benefit checks.

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Tier 1: General Published Rates Across 9 InsurancesEvery cell labeled with official Source + Date • “Not published” shown honestly where proprietary

Hospital procedure cells are extracted from 14 Bay Area hospital MRFs (45 CFR § 180.50, Oct 2026); medication cells use CMS NADAC (as of 2026-10-28) & CY 2026 Medicare Part D / Medi-Cal Rx rules.

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Parkinson's Service / Medication	Self-Pay / Cash Price Hospital MRF / Retail Cash	Medicare Rate 2026 CMS / NADAC / Part D	Anthem Blue Cross MRF Negotiated / Formulary	Blue Shield of CA MRF Negotiated / Formulary	UnitedHealthcare MRF Negotiated / Formulary	Aetna MRF Negotiated / Formulary	Cigna MRF Negotiated / Formulary	Kaiser Permanente MRF Negotiated / Formulary	Medi-Cal (CA Medicaid) CA DHCS / Medi-Cal Rx
Pathway ServiceCPT 97110 Physical Therapy — Therapeutic Exercise (Per 15-Min Unit) 14-Hospital Breakdown →	$58–$268 Self-pay discounted cash / negotiated spread ($16–$336 overall across 14 Bay Area hospitals) Source: 14 Bay Area Hospital MRFs (45 CFR § 180.50) Date: Oct 2026	$35.91 CMS 2026 allowed rate (~$7.18 Part B 20% coinsurance; $0 with Medigap Plan G) Source: CMS CY 2026 Medicare Physician & Outpatient Therapy Fee Schedule (CPT 97110) Date: CY 2026 (Jan 2026)	$30–$256 Negotiated across 5 Bay Area hospital MRFs (e.g., Washington Hospital (Fremont): ANTHEM BC FEDERAL EMPLOYEES ($256); Summit Medical Center (Oakland): Anthem (Medicare Adv_ HMO / PPO) ($30)) Source: Bay Area Hospital MRFs (5/14 facilities, 45 CFR § 180.50) Date: 2026-10-01	$36–$207 Negotiated across 3 Bay Area hospital MRFs (e.g., UCSF Medical Center (SF): Blue Shield (Medicare Managed Care Plan) ($38); Stanford Tri-Valley (Pleasanton): Blue Shield (HMO/POS) ($118)) Source: Bay Area Hospital MRFs (3/14 facilities, 45 CFR § 180.50) Date: 2026-10-01	$36–$306 Negotiated across 2 Bay Area hospital MRFs (e.g., UCSF Medical Center (SF): Unitedhealthcare (Medicare Managed Care Plan) ($37); Washington Hospital (Fremont): UHC MCR ADV ($36)) Source: Bay Area Hospital MRFs (2/14 facilities, 45 CFR § 180.50) Date: 2026-10-01	$36–$189 Negotiated across 1 Bay Area hospital MRFs (e.g., Washington Hospital (Fremont): AETNA MCR ADV ($36); Washington Hospital (Fremont): AETNA-ALL OTHER PLANS ($189)) Source: Bay Area Hospital MRFs (1/14 facilities, 45 CFR § 180.50) Date: 2026-10-01	$165–$283 Negotiated across 1 Bay Area hospital MRFs (e.g., Washington Hospital (Fremont): CIGNA NEW BUS OAP ($220)) Source: Bay Area Hospital MRFs (1/14 facilities, 45 CFR § 180.50) Date: 2026-10-01	$16–$191 Negotiated across 1 Bay Area hospital MRFs (e.g., Washington Hospital (Fremont): KAISER MCR ADV ($36); Washington Hospital (Fremont): KAISER MEDI-CAL ($16)) Source: Bay Area Hospital MRFs (1/14 facilities, 45 CFR § 180.50) Date: 2026-10-01	$0 patient copay Medi-Cal Fee-For-Service / Managed Care ($0 beneficiary cost-sharing; provider benchmark ~$29) Source: CA DHCS 2026 Medi-Cal Rates & Cost-Sharing Rules Date: Oct 2026

Audit-Grade Cell Verification (9/9 Insurance Columns Sourced)

Every Insurance Cell for Physical Therapy — With Source & Date Citations

Tier 1 Cash Baseline Published Rate

Self-Pay / Discounted Cash Price

$58–$268

Self-pay discounted cash / negotiated spread ($16–$336 overall across 14 Bay Area hospitals)

Official Source: 14 Bay Area Hospital MRFs (45 CFR § 180.50)

Effective / Verified Date: Oct 2026

Federal Benchmark Published Rate

Original Medicare (CMS 2026 / NADAC / Part D)

$35.91

CMS 2026 allowed rate (~$7.18 Part B 20% coinsurance; $0 with Medigap Plan G)

Official Source: CMS CY 2026 Medicare Physician & Outpatient Therapy Fee Schedule (CPT 97110)

Effective / Verified Date: CY 2026 (Jan 2026)

Commercial & MA MRF Published Rate

Anthem Blue Cross (California)

$30–$256

Negotiated across 5 Bay Area hospital MRFs (e.g., Washington Hospital (Fremont): ANTHEM BC FEDERAL EMPLOYEES ($256); Summit Medical Center (Oakland): Anthem (Medicare Adv_ HMO / PPO) ($30))

Official Source: Bay Area Hospital MRFs (5/14 facilities, 45 CFR § 180.50)