CMS Price Transparency Data

Physical therapy (therapeutic exercise)

Facility: Breckinridge Memorial Hospital

Billing Code: 97110 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97110
Insurance Median: $71
Cash Discount Price: $99
vs. Medicare Baseline: 2.44x Medicare

The contracted insurance negotiated median rate for a Physical therapy (therapeutic exercise) at Breckinridge Memorial Hospital is $71. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $99. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 2.44x the Medicare baseline. Located in 1011 Old Highway 60, Hardinsburg, KY.

Cash / Self-Pay

$99

Average discount available for prompt cash payment at this facility.

Insurance Median

$71

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: $99 (341%)

Insurance Median: $71 (244%)

Cash: $99 (341% of Medicare)

Ins. Median: $71 (244% 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 244% of the Medicare baseline (a markup of 144%). 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	$21 - $148	72%
Blue Cross Blue Shield	$21 - $198	72%
Wellcare Mcaid - All Other Plans	$21	72%
Tricare	$64	220%
Molina Mcr Adv - All Plans	$69	237%
University Health Care - All Other Plans	$69	237%
Caresource - All Plans	$71	244%
UnitedHealthcare	$71 - $168	244%
University Health Care Mcr Adv	$71	244%
Wellcare Mcr Adv	$71	244%
Ambetter / Centene	$78	268%
Humana	$148	509%

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 $99.
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 Breckinridge Memorial 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.