CMS Price Transparency Data

Physical therapy (therapeutic exercise)

Facility: Holy Family Memorial

Billing Code: 97110 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97110
Insurance Median: $137
Cash Discount Price: $105
vs. Medicare Baseline: 4.71x Medicare

The contracted insurance negotiated median rate for a Physical therapy (therapeutic exercise) at Holy Family Memorial is $137. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $105. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 4.71x the Medicare baseline. Located in 2300 Western Ave, Manitowoc, WI.

Cash / Self-Pay

$105

Average discount available for prompt cash payment at this facility.

Insurance Median

$137

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: $105 (361%)

Insurance Median: $137 (471%)

Cash: $105 (361% of Medicare)

Ins. Median: $137 (471% 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 471% of the Medicare baseline (a markup of 371%). 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
Blue Cross Blue Shield	$28 - $248	96%
Community Care Incorporated	$28	96%
Health Partners	$28 - $124	96%
Humana	$28	96%
Icare	$28	96%
Molina	$28 - $30	96%
Network Health Plan	$28 - $263	96%
Security Health Plan	$28 - $152	96%
UnitedHealthcare	$28 - $370	96%
Allwell	$29	100%
Medical College Of Wisconsin	$63	217%
Centivo	$76 - $87	262%
Dean Health Plan	$95	327%
Health Payment Systems	$107	368%
Sheboygan Employers Health Network	$114	392%
Chorus Community Health Plan	$122	420%
Trilogy	$125	430%
Cigna	$137	471%
Wps Health Plan	$141	485%
Aspirus	$152	523%
Healtheos	$152	523%
Multiplan/Private Healthcare Systems	$152	523%
Preferred One	$152	523%
Healthsmart	$158	544%
First Health Network	$167	575%

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 $105.
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 Holy Family Memorial 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.