CMS Price Transparency Data

Physical therapy (manual therapy)

Facility: Tomah Memorial Hospital

Billing Code: 97140 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97140
Insurance Median: $83
Cash Discount Price: $80
vs. Medicare Baseline: 2.99x Medicare

The contracted insurance negotiated median rate for a Physical therapy (manual therapy) at Tomah Memorial Hospital is $83. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $80. Compared to the federal Medicare reimbursement reference rate of $27.72, this hospital’s rate is 2.99x the Medicare baseline. Located in 501 Gopher Dr, Tomah, WI.

Cash / Self-Pay

$80

Average discount available for prompt cash payment at this facility.

Insurance Median

$83

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: $80 (289%)

Insurance Median: $83 (299%)

Cash: $80 (289% of Medicare)

Ins. Median: $83 (299% 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 299% of the Medicare baseline (a markup of 199%). 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	$43 - $176	155%
Group Hlth Mcr Adv - All Plans	$43 - $65	155%
Humana	$43 - $177	155%
Independent Care Mcr - All Other Plans	$43 - $65	155%
Quartz Mcr Adv	$43 - $65	155%
Security Hp Mcr Adv	$43 - $65	155%
UnitedHealthcare	$43 - $181	155%
Va Ccn - All Plans	$43 - $65	155%
Independent Care Mcaid	$55	198%
Managed Hlth Mcaid - All Plans	$55	198%
Quartz Mcaid	$55	198%
Security Hp Mcaid	$55	198%
Aetna	$83 - $163	299%
Cigna	$97 - $186	350%
Security Hp Comm - All Other Plans	$108 - $163	390%
Quartz Comm - All Other Plans	$115 - $172	415%
The Alliance - All Plans	$118 - $178	426%

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 $80.
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 Tomah Memorial Hospital 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.