CMS Price Transparency Data

Physical therapy (neuromuscular re-education)

Facility: St Josephs Community Hospital West Bend

Billing Code: 97112 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97112
Insurance Median: $159
Cash Discount Price: $108
vs. Medicare Baseline: 4.86x Medicare

The contracted insurance negotiated median rate for a Physical therapy (neuromuscular re-education) at St Josephs Community Hospital West Bend is $159. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $108. Compared to the federal Medicare reimbursement reference rate of $32.73, this hospital’s rate is 4.86x the Medicare baseline. Located in 3200 Pleasant Valley Road, West Bend, WI.

Cash / Self-Pay

$108

Average discount available for prompt cash payment at this facility.

Insurance Median

$159

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$32.73

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $32.73 (100%)

Cash / Self-Pay: $108 (330%)

Insurance Median: $159 (486%)

Cash: $108 (330% of Medicare)

Ins. Median: $159 (486% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $32.73 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 486% of the Medicare baseline (a markup of 386%). 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	$31	95%
Blue Cross Blue Shield	$31 - $327	95%
Community Care	$31	95%
Health Partners	$31 - $128	95%
Humana	$31	95%
Icare	$31	95%
Molina	$31	95%
Network Health Plan	$31 - $263	95%
Security Health Plan Secure Savers	$31	95%
UnitedHealthcare	$31 - $370	95%
Aetna	$32 - $138	98%
Care Wisconsin	$32	98%
Centivo	$59 - $65	180%
Froedtert South	$83	254%
Chorus Community Health Plan	$85	260%
Common Ground	$118	361%
Health Payment Systems	$124 - $159	379%
Wisconsin Physician Services	$158	483%
Trilogy	$162	495%
Americas Choice	$171	522%
Healtheos	$171	522%
Multiplan/Private Healthcare Systems	$171	522%
First Health Network	$173	529%
Hfn	$177	541%
Ibsi Passport	$177	541%
Cigna	$187	571%
Healthsmart	$187	571%
Sheboygan Employers Health Network	$397	1213%

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 $108.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 97112.

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 97112.
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.