CMS Price Transparency Data

Group therapy session

Facility: Marshfield Medical Center - Beaver Dam (Mmc-Bd)

Billing Code: 90853 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90853
Insurance Median: $32
Cash Discount Price: $38
vs. Medicare Baseline: 0.31x Medicare

The contracted insurance negotiated median rate for a Group therapy session at Marshfield Medical Center - Beaver Dam (Mmc-Bd) is $32. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $38. Compared to the federal Medicare reimbursement reference rate of $103.79, this hospital’s rate is 0.31x the Medicare baseline. Located in 707 S University Ave, Beaver Dam, WI.

Cash / Self-Pay

$38

Average discount available for prompt cash payment at this facility.

Insurance Median

$32

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$103.79

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $103.79 (100%)

Cash / Self-Pay: $38 (37%)

Insurance Median: $32 (31%)

Cash: $38 (37% of Medicare)

Ins. Median: $32 (31% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $103.79 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.

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
The Alliance	$17 - $23	16%
Security Health Plan (Shp)	$18 - $88	17%
Amish/Mennonite	$19 - $25	18%
Quartz	$19 - $88	18%
Cigna	$23 - $33	22%
Wps Health Insurance	$23 - $30	22%
Health Payment Systems	$24 - $31	23%
UnitedHealthcare	$25 - $88	24%
Humana	$27 - $88	26%
Group Health Cooperative Of Eau Claire	$28 - $93	27%
Network Health Plan	$28 - $88	27%
First Health	$29 - $38	28%
Molina Healthcare Of Wi	$29 - $88	28%
Trilogy	$31 - $40	30%
Health Partners	$32 - $43	31%
Healtheos By Multiplan Inc.	$32 - $43	31%
Coventry	$33 - $43	32%
Managed Health Services	$88	85%
Veteran'S Administration (Va Ccn)	$88	85%
Blue Cross Blue Shield	$91 - $477	88%
Icare	$94	91%

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 $38.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 90853.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Marshfield Medical Center - Beaver Dam (Mmc-Bd) is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 90853.
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.