CMS Price Transparency Data

Physical therapy (manual therapy)

Facility: Gundersen St Josephs Hospital and Clinics

Billing Code: 97140 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97140
Insurance Median: $139
Cash Discount Price: $110
vs. Medicare Baseline: 5.01x Medicare

The contracted insurance negotiated median rate for a Physical therapy (manual therapy) at Gundersen St Josephs Hospital and Clinics is $139. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $110. Compared to the federal Medicare reimbursement reference rate of $27.72, this hospital’s rate is 5.01x the Medicare baseline. Located in 400 Water Ave, Hillsboro, WI.

Cash / Self-Pay

$110

Average discount available for prompt cash payment at this facility.

Insurance Median

$139

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$27.72

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $27.72 (100%)

Cash / Self-Pay: $110 (397%)

Insurance Median: $139 (501%)

Cash: $110 (397% of Medicare)

Ins. Median: $139 (501% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $27.72 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 501% of the Medicare baseline (a markup of 401%). 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	54%
Security Health Plan	$37	133%
Blue Cross Blue Shield	$94 - $352	339%
Iowa Total Care	$94	339%
Managed Health Service	$94	339%
Ucare	$99 - $152	357%
UnitedHealthcare	$101 - $133	364%
Quartz	$104	375%
Alliance	$108 - $161	390%
Cigna	$156	563%
Aspirus Arise Health	$158	570%
Humana	$162	584%
Multiplan/Healtheos	$165 - $180	595%
Coventry Health Care	$180	649%

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 $110.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 97140.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Gundersen St Josephs Hospital and Clinics is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 97140.
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.