Good Faith Estimate 

According to the Good Faith Estimate provision within the No Surprises Act, health care providers and facilities, as of January 1, 2022, must provide a Good Faith Estimate of expected charges upon request. This law pertains to patients who do not have insurance or are not using insurance (private pay). For additional information on Good Faith Estimates, read the disclaimer posted under the chart. 

Therapy after Surgery

Good Faith Estimates

*Your actual visits may vary from the above numbers based on your severity and/or complexity. Appointments are typically 20-40 minutes in length.

OMB Control Number 0938-XXXX
Expiration Date  01/01/2024

This Good Faith Estimate shows the costs of items and services that are reasonably expected for your health care needs for an item or service. The estimate is based on information known at the time the estimate was created. 

The Good Faith Estimate does not include any unknown or unexpected costs that may arise during treatment. You could be charged more if complications or special circumstances occur. If this happens, federal law allows you to dispute (appeal) the bill. 

If you are billed for more than this Good Faith Estimate, you have the right to dispute the bill. 

You may contact the health care provider or facility listed to let them know the billed charges are higher than the Good Faith Estimate. You can ask them to update the bill to match the Good Faith Estimate, ask to negotiate the bill, or ask if there is financial assistance available. 

You may also start a dispute resolution process with the U.S. Department of Health and Human Services (HHS). If you choose to use the dispute resolution process, you must start the dispute process within 120 calendar days (about 4 months) of the date on the original bill. 

There is a $25 fee to use the dispute process. If the agency reviewing your dispute agrees with you, you will have to pay the price on this Good Faith Estimate. If the agency disagrees with you and agrees with the health care provider or facility, you will have to pay the higher amount. 

To learn more and get a form to start the process, go to or call 1-877-696-6775. 

For questions or more information about your right to a Good Faith Estimate or the dispute process, visit or call 1-877-696-6775. 

Keep a copy of this Good Faith Estimate in a safe place or take pictures of it. 
You may need it if you are billed a higher amount.

Common Charges

Most insurance carriers individually discount for the prices below and pay according to your plan design - your co-pay/deductible/co-insurance is also based on your plan design.

Treatment/CPT Code Billed as a single unit: Medicare Reimbursement:
Moderate PT Evaluation/97162 (visit 1) $212 $94.35
PT Re-Evaluation/97164 $108 $64.31
Neuromuscular Re-Education/97112 $86 $24.71
Manual Therapy/97140 $82.95  $20.06
Therapeutic Exercise/97110 $82.95 $21.55
Therapeutic Activities/97530 $82.95 $36.19
Cash-Based Programs $55                                                              At time of Service

*Insurance/Billing questions or concerns, contact us at or 1-844-919-5172; and check with your insurance carrier.



Are you experiencing pain related to a sports injury or accident? Not sure where to start? We believe that when given the proper attention and the right environment, the body may begin to heal itself.



EAU CLAIRE Located in the Putnam Heights Shopping Center

517 East Clairemont Ave. | Eau Claire, WI 54701
Phone: 715.855.0408 | Fax: 715.855.0409
  • view hours
  • Eau Claire Hours:
    Monday - 7:00 to 5:00
    Tuesday - 8:00 to 6:00
    Wednesday - 7:00 to 5:00
    Thursday - 8:00 to 6:00
    Friday - 7:00 to 5:00

  • GET DIRECTIONS get directions
Take a Tour
MENOMONIE Located across from Culvers

1309 Stout Road | Menomonie, WI 54751
Phone: 715.233.6230 | Fax: 715.233.6231
  • view hours
  • Menomonie Hours:
    Monday - 8:00 to 5:00
    Tuesday - 7:00 to 6:00
    Wednesday - 8:00 to 5:00
    Thursday - 8:00 to 6:00
    Friday - 7:00 to 5:00

  • Direction get directions
Take a Tour

1507 W. Knapp St., Suite #1 | Rice Lake, WI 54868
Phone: 715.236.3610 | Fax: 715.236.3615
Take a Tour

1151 E. Division Avenue, Unit B | Barron, WI 54812
Phone: 715.637.3610 | Fax: 715.537.4610

3028 Commercial Blvd | Chippewa Falls, WI 54729
Phone: 715.855.0426 | Fax: 715.855.8766