CMS Price Transparency Data

Physical therapy (functional capacity test)

Facility: Holy Family Memorial

Billing Code: 97750 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97750
Insurance Median: $148
Cash Discount Price: $113
vs. Medicare Baseline: 4.39x Medicare

The contracted insurance negotiated median rate for a Physical therapy (functional capacity test) at Holy Family Memorial is $148. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $113. Compared to the federal Medicare reimbursement reference rate of $33.73, this hospital’s rate is 4.39x the Medicare baseline. Located in 2300 Western Ave, Manitowoc, WI.

Cash / Self-Pay

$113

Average discount available for prompt cash payment at this facility.

Insurance Median

$148

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: $113 (335%)

Insurance Median: $148 (439%)

Cash: $113 (335% of Medicare)

Ins. Median: $148 (439% 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 439% of the Medicare baseline (a markup of 339%). 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	$32 - $248	95%
Community Care Incorporated	$32	95%
Health Partners	$32 - $133	95%
Humana	$32	95%
Icare	$32	95%
Molina	$32 - $35	95%
Network Health Plan	$32 - $263	95%
Security Health Plan	$32 - $164	95%
UnitedHealthcare	$32 - $370	95%
Allwell	$33	98%
Medical College Of Wisconsin	$68	202%
Centivo	$82 - $94	243%
Dean Health Plan	$102	302%
Health Payment Systems	$116	344%
Sheboygan Employers Health Network	$123	365%
Chorus Community Health Plan	$132	391%
Trilogy	$135	400%
Cigna	$148	439%
Wps Health Plan	$152	451%
Aspirus	$164	486%
Healtheos	$164	486%
Multiplan/Private Healthcare Systems	$164	486%
Preferred One	$164	486%
Healthsmart	$170	504%
First Health Network	$180	534%

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 $113.
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 Holy Family Memorial 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.