CMS Price Transparency Data

Physical therapy (manual therapy)

Facility: Stoughton Hospital

Billing Code: 97140 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97140
Insurance Median: $112
Cash Discount Price: $106
vs. Medicare Baseline: 4.04x Medicare

The contracted insurance negotiated median rate for a Physical therapy (manual therapy) at Stoughton Hospital is $112. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $106. Compared to the federal Medicare reimbursement reference rate of $27.72, this hospital’s rate is 4.04x the Medicare baseline. Located in 900 Ridge St, Stoughton, WI.

Cash / Self-Pay

$106

Average discount available for prompt cash payment at this facility.

Insurance Median

$112

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: $106 (382%)

Insurance Median: $112 (404%)

Cash: $106 (382% of Medicare)

Ins. Median: $112 (404% 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 404% of the Medicare baseline (a markup of 304%). 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
Medicaid / KanCare	$42	152%
Tricare	$46	166%
Healthnet Mcr Adv - All Plans	$51	184%
Dean Health Insurance Med Adv	$54	195%
Humana	$54 - $174	195%
Quartz Mcr Adv	$54	195%
Security Health/First Health - All Plans	$54	195%
Aetna	$58 - $164	209%
UnitedHealthcare	$85 - $154	307%
Quartz Health Solutions - All Other Lans	$111	400%
Alliance - All Plans	$112	404%
Dean Health Insurance Epo	$119	429%
Dean Health Insurance Comm - All Other Plans	$145	523%
Geha - All Plans	$145	523%
Cigna	$154	556%
Wisconsin Ppo Ppa Direct - All Plans	$154	556%
Blue Cross Blue Shield	$168	606%
Wps - All Plans	$174	628%

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 $106.
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 Stoughton 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.