CMS Price Transparency Data

Orthotic fitting and training

Facility: St Josephs Community Hospital West Bend

Billing Code: 97760 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97760
Insurance Median: $148
Cash Discount Price: $101
vs. Medicare Baseline: 3.21x Medicare

The contracted insurance negotiated median rate for a Orthotic fitting and training at St Josephs Community Hospital West Bend is $148. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $101. Compared to the federal Medicare reimbursement reference rate of $46.09, this hospital’s rate is 3.21x the Medicare baseline. Located in 3200 Pleasant Valley Road, West Bend, WI.

Cash / Self-Pay

$101

Average discount available for prompt cash payment at this facility.

Insurance Median

$148

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$46.09

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $46.09 (100%)

Cash / Self-Pay: $101 (219%)

Insurance Median: $148 (321%)

Cash: $101 (219% of Medicare)

Ins. Median: $148 (321% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $46.09 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 321% of the Medicare baseline (a markup of 221%). 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
Allwell	$44	95%
Blue Cross Blue Shield	$44 - $327	95%
Community Care	$44	95%
Health Partners	$44 - $119	95%
Humana	$44	95%
Icare	$44	95%
Molina	$44	95%
Network Health Plan	$44 - $263	95%
Security Health Plan Secure Savers	$44	95%
UnitedHealthcare	$44 - $370	95%
Aetna	$45 - $128	98%
Care Wisconsin	$46	100%
Centivo	$55 - $60	119%
Froedtert South	$77	167%
Chorus Community Health Plan	$79	171%
Common Ground	$110	239%
Health Payment Systems	$115 - $148	250%
Wisconsin Physician Services	$146	317%
Trilogy	$150	325%
Americas Choice	$159	345%
Healtheos	$159	345%
Multiplan/Private Healthcare Systems	$159	345%
First Health Network	$161	349%
Hfn	$165	358%
Ibsi Passport	$165	358%
Cigna	$174	378%
Healthsmart	$174	378%
Sheboygan Employers Health Network	$397	861%

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 $101.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 97760.

Insurance In-Network Protection Plan

Contact your insurance company to confirm St Josephs Community Hospital West Bend is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 97760.
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.