CMS Price Transparency Data

Group therapy session

Facility: West Allis Memorial Hospital

Billing Code: 90853 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90853
Insurance Median: $159
Cash Discount Price: $123
vs. Medicare Baseline: 1.53x Medicare

The contracted insurance negotiated median rate for a Group therapy session at West Allis Memorial Hospital is $159. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $123. Compared to the federal Medicare reimbursement reference rate of $103.79, this hospital’s rate is 1.53x the Medicare baseline. Located in 8901 W Lincoln Ave, West Allis, WI.

Cash / Self-Pay

$123

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

$103.79

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $103.79 (100%)

Cash / Self-Pay: $123 (119%)

Insurance Median: $159 (153%)

Cash: $123 (119% of Medicare)

Ins. Median: $159 (153% 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
Everpointe Elite	$122	118%
Hs Technology	$122	118%
Aetna	$131 - $15,600	126%
Quartz One	$135	130%
UnitedHealthcare	$146 - $206	141%
Aurora Caregiver	$147	142%
Blue Cross Blue Shield	$147 - $208	142%
Common Ground	$147	142%
Health Eos Plus	$147	142%
Healthpartners	$147 - $184	142%
Molina Exchange	$147	142%
Quartz Group	$147	142%
Wisconsin Physician Service	$152 - $159	146%
Health Payment Systems	$159	153%
Trilogy	$172	166%
Centivo	$184	177%
Cigna	$184 - $207	177%
Health Eos	$196	189%

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 $123.
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 West Allis Memorial Hospital 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.