CMS Price Transparency Data

Physical therapy (therapeutic exercise)

Facility: St Josephs Community Hospital West Bend

Billing Code: 97110 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97110
Insurance Median: $132
Cash Discount Price: $90
vs. Medicare Baseline: 4.54x Medicare

The contracted insurance negotiated median rate for a Physical therapy (therapeutic exercise) at St Josephs Community Hospital West Bend is $132. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $90. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 4.54x the Medicare baseline. Located in 3200 Pleasant Valley Road, West Bend, WI.

Cash / Self-Pay

$90

Average discount available for prompt cash payment at this facility.

Insurance Median

$132

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$29.06

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $29.06 (100%)

Cash / Self-Pay: $90 (310%)

Insurance Median: $132 (454%)

Cash: $90 (310% of Medicare)

Ins. Median: $132 (454% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $29.06 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 454% of the Medicare baseline (a markup of 354%). 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	$28	96%
Blue Cross Blue Shield	$28 - $327	96%
Community Care	$28	96%
Health Partners	$28 - $106	96%
Humana	$28	96%
Icare	$28	96%
Molina	$28	96%
Network Health Plan	$28 - $263	96%
Security Health Plan Secure Savers	$28	96%
UnitedHealthcare	$28 - $370	96%
Aetna	$29 - $114	100%
Care Wisconsin	$29	100%
Centivo	$49 - $54	169%
Froedtert South	$68	234%
Chorus Community Health Plan	$70	241%
Common Ground	$98	337%
Health Payment Systems	$103 - $132	354%
Wisconsin Physician Services	$130	447%
Trilogy	$134	461%
Americas Choice	$142	489%
Healtheos	$142	489%
Multiplan/Private Healthcare Systems	$142	489%
First Health Network	$143	492%
Hfn	$147	506%
Ibsi Passport	$147	506%
Cigna	$155	533%
Healthsmart	$155	533%
Sheboygan Employers Health Network	$397	1366%

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 $90.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 97110.

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 97110.
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.