CMS Price Transparency Data

Physical therapy (functional capacity test)

Facility: University of Wi Hospitals & Clinics Authority

Billing Code: 97750 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97750
Insurance Median: $113
Cash Discount Price: $103
vs. Medicare Baseline: 3.35x Medicare

The contracted insurance negotiated median rate for a Physical therapy (functional capacity test) at University of Wi Hospitals & Clinics Authority is $113. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $103. Compared to the federal Medicare reimbursement reference rate of $33.73, this hospital’s rate is 3.35x the Medicare baseline. Located in 600 Highland Avenue, Madison, WI.

Cash / Self-Pay

$103

Average discount available for prompt cash payment at this facility.

Insurance Median

$113

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: $103 (305%)

Insurance Median: $113 (335%)

Cash: $103 (305% of Medicare)

Ins. Median: $113 (335% 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 335% of the Medicare baseline (a markup of 235%). 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
Medicare (plans)	$46 - $132	136%
Alliance_Premier_Network	$74 - $90	219%
Mercycare	$77 - $93	228%
Triology	$79 - $115	234%
Security_Health_Plan	$84 - $119	249%
Employer'S_Coalition_On_Health	$85 - $145	252%
Alliance	$87 - $106	258%
Hfn	$88 - $145	261%
United_Healthcare	$89 - $160	264%
Beloit_Health_System	$90 - $109	267%
Aspirus_Health_Plan	$91 - $110	270%
Cigna	$93 - $113	276%
Health_Partners_Insurance	$95 - $115	282%
Health_Payment_Systems	$95 - $115	282%
UnitedHealthcare	$97 - $118	288%
Dean_Health_Plan	$99 - $120	294%
Medical_Associates	$102 - $124	302%
Wps	$107 - $143	317%
Employers_Healthcare_Coalition_Of_Wi	$108 - $132	320%
Aetna	$111 - $151	329%
Blue Cross Blue Shield	$111 - $350	329%
Aspirus_Network_Inc	$119 - $145	353%
Chorus_Community	$124 - $150	368%
Ghc_Eau_Claire_Health_Plan	$124 - $150	368%
Multiplan	$124 - $173	368%
Sheybogan_Employers_Health_Network	$124 - $150	368%
Coventry	$132 - $160	391%
Dean_Care	$132 - $160	391%
Healthsmart	$136 - $165	403%

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 $103.
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 University of Wi Hospitals & Clinics Authority 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.