CMS Price Transparency Data

Physical therapy (therapeutic exercise)

Facility: Gundersen Lutheran Medical Center

Billing Code: 97110 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97110
Insurance Median: $88
Cash Discount Price: $71
vs. Medicare Baseline: 3.03x Medicare

The contracted insurance negotiated median rate for a Physical therapy (therapeutic exercise) at Gundersen Lutheran Medical Center is $88. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $71. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 3.03x the Medicare baseline. Located in 1910 South Ave, La Crosse, WI.

Cash / Self-Pay

$71

Average discount available for prompt cash payment at this facility.

Insurance Median

$88

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: $71 (244%)

Insurance Median: $88 (303%)

Cash: $71 (244% of Medicare)

Ins. Median: $88 (303% 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 303% of the Medicare baseline (a markup of 203%). 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
Amerigroup	$15 - $37	52%
Blue Cross Blue Shield	$15 - $486	52%
Group Health Eau Claire	$15 - $168	52%
Group Health Of South Central	$15 - $150	52%
Icare	$15 - $37	52%
Iowa Total Care	$15	52%
Managed Health Service	$15	52%
Molina Health	$15	52%
UnitedHealthcare	$15 - $152	52%
Aetna	$37 - $178	127%
Medical Associates	$37 - $140	127%
Ucare	$37 - $150	127%
Medica	$62 - $143	213%
Dean Health Plan	$78	268%
Quartz	$79	272%
Health Partners	$94 - $165	323%
Alliance	$117 - $157	403%
Midland Choice	$140	482%
Claim Doc Llc	$150	516%
Wps Narrow Network	$152	523%
Cigna	$153	526%
Wps - Arise	$154	530%
Aspirus Arise Health	$155	533%
Allied National General	$159	547%
Preferred One	$159	547%
Wps Statewide	$159	547%
Coventry Health Care	$178	613%
Humana	$178	613%
Multiplan/Healtheos	$180	619%

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 $71.
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 Gundersen Lutheran Medical Center 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.