CMS Price Transparency Data

Physical therapy (functional capacity test)

Facility: Holy Family Memorial

Billing Code: 97750 (CPT)

The BaseRate · fair price medium confidence

A fair price for this

$62

about 1.8× the $34 Medicare rate · typically $33–$108

modeled estimate · not a bill or quote

What this hospital charges insurers

$33

Below the fair price — a good deal

about $29 under the fair price · 1.0× Medicare

Medicare pays $34 Fair price $62 This hospital $33 Cash price $113 Hospital's list price $205

How we calculate the fair BaseRate →

How this hospital compares to other WI hospitals

Highest price of the 9 WI hospitals we have prices for — worth calling around.

Cheapest $29 Priciest $33

Black dot = this hospital, among the 9 WI hospitals with a price for this procedure. Full list below.

⚠ The cash price looks unusually high next to the insurance price — it may be the full list price, not a real cash discount. Call to confirm the self-pay rate.

A fair price for a Physical therapy (functional capacity test) is about $62 (about 1.8× the $34 Medicare rate). Holy Family Memorial charges insurers about $33, or about $113 in cash — below the fair price — a good deal. Located in Manitowoc, WI.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

4 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Cigna✓ Humana AetnaKaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$32 - $370	95%
Blue Cross Blue Shieldmajor	$32 - $248	95%
Cignamajor	$148	439%
Humanamajor	$32	95%
Dean Health Plan	$102	302%
Health Net	$123	365%
HealthPartners	$32 - $133	95%
Molina	$32 - $35	95%
Security Health Plan	$32 - $164	95%
+ 13 smaller / regional plans	$32 - $263

Excludes 3 rental-network / third-party entries (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price (about 113), before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the CPT code on your bill matches exactly: 97750.

Insurance Before you use insurance

Call your insurance company to confirm Holy Family Memorial is in-network.
Ask your insurer whether prior approval is required for CPT code 97750.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at Holy Family Memorial

Compare: Physical therapy (functional capacity test) at other WI hospitals

Insurance negotiated median for the same procedure, sorted lowest first.