CMS Price Transparency Data
Physical therapy (functional capacity test)
Facility: Gundersen Moundview Hospital and Clinics
Billing Code: 97750 (CPT)
The BaseRate · fair price medium confidence
A fair price for this
$68
about 2.0× the $34 Medicare rate · typically $34–$172
modeled estimate · not a bill or quote
Medicare pays $34 Fair price $68 Cash price $71 Hospital's list price $138
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✓ Aetna✓ Humana CignaKaiser 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 | $160 | 474% |
| Blue Cross Blue Shieldmajor | $63 - $352 | 187% |
| Aetnamajor | $131 | 388% |
| Humanamajor | $117 | 347% |
| Amerigroup | $15 | 44% |
| Dean Health Plan | $110 | 326% |
| HealthPartners | $63 - $122 | 187% |
| Quartz | $75 | 222% |
| Security Health Plan | $63 | 187% |
| UCare | $63 - $110 | 187% |
| + 5 smaller / regional plans | $106 - $180 |
Excludes 1 rental-network / third-party entry (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.
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Other Procedures at Gundersen Moundview Hospital and Clinics
Compare: Physical therapy (functional capacity test) at other WI hospitals
- SSM Health St Clare Hospital - Baraboo · Baraboo $29
- SSM Health St Mary's Hospital - Madison · Madison $29
- St Josephs Community Hospital West Bend · West Bend $32
- Sauk Prairie Hospital · Prairie Du Sac $32
- Froedtert Memorial Lutheran Hospital · Milwaukee $32
- Froedtert Community Hospital · New Berlin $32
- The Monroe Clinic · Monroe $33
- SSM Health St Agnes Hospital-Fond Du Lac · Fond Du Lac $33
Insurance negotiated median for the same procedure, sorted lowest first.