CMS Price Transparency Data

Physical therapy (therapeutic exercise)

Facility: University of Wi Hospitals & Clinics Authority

Billing Code: 97110 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97110
Insurance Median: $124
Cash Discount Price: $118
vs. Medicare Baseline: 4.27x Medicare

The contracted insurance negotiated median rate for a Physical therapy (therapeutic exercise) at University of Wi Hospitals & Clinics Authority is $124. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $118. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 4.27x the Medicare baseline. Located in 600 Highland Avenue, Madison, WI.

Cash / Self-Pay

$118

Average discount available for prompt cash payment at this facility.

Insurance Median

$124

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: $118 (406%)

Insurance Median: $124 (427%)

Cash: $118 (406% of Medicare)

Ins. Median: $124 (427% 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 427% of the Medicare baseline (a markup of 327%). 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)	$59 - $137	203%
Blue Cross Blue Shield	$80 - $350	275%
Alliance_Premier_Network	$94	323%
Mercycare	$97	334%
Triology	$100 - $120	344%
Security_Health_Plan	$106 - $124	365%
Employer'S_Coalition_On_Health	$108 - $151	372%
Alliance	$110	379%
Hfn	$112 - $151	385%
United_Healthcare	$112 - $166	385%
Aspirus_Health_Plan	$114	392%
Beloit_Health_System	$114	392%
Cigna	$118	406%
Health_Partners_Insurance	$120	413%
Health_Payment_Systems	$120	413%
UnitedHealthcare	$123	423%
Dean_Health_Plan	$125	430%
Medical_Associates	$129	444%
Wps	$136 - $150	468%
Employers_Healthcare_Coalition_Of_Wi	$137	471%
Aetna	$140 - $157	482%
Aspirus_Network_Inc	$151	520%
Chorus_Community	$157	540%
Ghc_Eau_Claire_Health_Plan	$157	540%
Multiplan	$157 - $180	540%
Sheybogan_Employers_Health_Network	$157	540%
Coventry	$167	575%
Dean_Care	$167	575%
Healthsmart	$172	592%

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 $118.
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 University of Wi Hospitals & Clinics Authority 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.