CMS Price Transparency Data

Physical therapy (therapeutic exercise)

Facility: Kapiolani Medical Center for Women & Children

Billing Code: 97110 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97110
Insurance Median: $80
Cash Discount Price: $95
vs. Medicare Baseline: 2.75x Medicare

The contracted insurance negotiated median rate for a Physical therapy (therapeutic exercise) at Kapiolani Medical Center for Women & Children is $80. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $95. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 2.75x the Medicare baseline. Located in 1319 Punahou Street, Honolulu, HI.

Cash / Self-Pay

$95

Average discount available for prompt cash payment at this facility.

Insurance Median

$80

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: $95 (327%)

Insurance Median: $80 (275%)

Cash: $95 (327% of Medicare)

Ins. Median: $80 (275% 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 275% of the Medicare baseline (a markup of 175%). 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
Ohana	$19 - $52	65%
UnitedHealthcare	$26 - $53	89%
Alohacare	$37 - $52	127%
Hmsa	$37 - $38	127%
Kaiser	$37 - $156	127%
Mdx	$37 - $142	127%
Devoted	$39	134%
Uha	$47 - $3,145	162%
Mimoh	$99 - $133	341%
Hwmg/Hmaa	$112 - $141	385%
Hcha	$113 - $142	389%
Multiplan	$113 - $150	389%
Verdegard	$113 - $142	389%
Mccp	$120 - $150	413%
Coventry	$127 - $159	437%

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 $95.
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 Kapiolani Medical Center for Women & Children 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.