CMS Price Transparency Data

Physical therapy (functional capacity test)

Facility: Holland Community Hospital

Billing Code: 97750 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97750
Insurance Median: $79
Cash Discount Price: $71
vs. Medicare Baseline: 2.34x Medicare

The contracted insurance negotiated median rate for a Physical therapy (functional capacity test) at Holland Community Hospital is $79. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $71. Compared to the federal Medicare reimbursement reference rate of $33.73, this hospital’s rate is 2.34x the Medicare baseline. Located in 602 Michigan Ave, Holland, MI.

Cash / Self-Pay

$71

Average discount available for prompt cash payment at this facility.

Insurance Median

$79

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$33.73

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $33.73 (100%)

Cash / Self-Pay: $71 (210%)

Insurance Median: $79 (234%)

Cash: $71 (210% of Medicare)

Ins. Median: $79 (234% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $33.73 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 234% of the Medicare baseline (a markup of 134%). 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
Life Circles-All Plans	$31	92%
Health Alliance Mcr Adv	$32	95%
Ph Mcr Adv	$32	95%
Va Ccn - All Plans	$32	95%
Aetna	$33 - $94	98%
Longevity Health Plan-All Plans	$35	104%
Molina Mcaid - All Plans	$38	113%
Ph Mcaid	$38	113%
Sisco Epi	$55	163%
Sisco-All Other Plans	$55	163%
Blue Cross Blue Shield	$64	190%
Health Alliance Hmo	$73	216%
Asr - All Plans	$76	225%
Health Alliance Ahl - All Other Plans	$76	225%
Cofinity -All Plans	$83	246%
UnitedHealthcare	$90 - $118	267%
Multiplan - All Plans	$103	305%
Benefit Source Inc-All Plans	$106	314%
First Health-All Plans	$106	314%
Usa Managed Care-All Plans	$106	314%
Integrated Health Plans-All Plans	$112	332%
Cigna	$115	341%
Priority Health - All Other Plans	$115	341%
Nomi Health - All Plans	$135	400%

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 $71.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 97750.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Holland Community Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 97750.
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.