CMS Price Transparency Data

Group therapy session

Facility: Unitypoint Health - Meriter

Billing Code: 90853 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90853
Insurance Median: $256
Cash Discount Price: $489
vs. Medicare Baseline: 2.47x Medicare

The contracted insurance negotiated median rate for a Group therapy session at Unitypoint Health - Meriter is $256. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $489. Compared to the federal Medicare reimbursement reference rate of $103.79, this hospital’s rate is 2.47x the Medicare baseline. Located in 202 S Park St, Madison, WI.

Cash / Self-Pay

$489

Average discount available for prompt cash payment at this facility.

Insurance Median

$256

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: $489 (471%)

Insurance Median: $256 (247%)

Cash: $489 (471% of Medicare)

Ins. Median: $256 (247% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 247% of the Medicare baseline (a markup of 147%). 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
Aspirus	$10 - $1,009	10%
Cigna	$12 - $504	12%
Security Health Plan	$13 - $521	13%
Mercy Care	$15 - $558	14%
Blue Cross Blue Shield	$24 - $1,597	23%
Illinicare	$24 - $89	23%
Prevea 360	$24 - $1,429	23%
UnitedHealthcare	$24 - $694	23%
Humana	$25 - $89	24%
Meridiancare	$25 - $89	24%
Health Partners Open Network	$35 - $614	34%
Wellmark Uph Self-Funded	$71 - $970	68%
Medical Associates Health Plan	$102 - $605	98%
Quartz	$124 - $524	119%

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 $489.
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 Unitypoint Health - Meriter 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.