CMS Price Transparency Data

Group therapy session

Facility: Froedtert Memorial Lutheran Hospital

Billing Code: 90853 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90853
Insurance Median: $196
Cash Discount Price: $174
vs. Medicare Baseline: 1.89x Medicare

The contracted insurance negotiated median rate for a Group therapy session at Froedtert Memorial Lutheran Hospital is $196. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $174. Compared to the federal Medicare reimbursement reference rate of $103.79, this hospital’s rate is 1.89x the Medicare baseline. Located in 9200 W Wisconsin Ave, Milwaukee, WI.

Cash / Self-Pay

$174

Average discount available for prompt cash payment at this facility.

Insurance Median

$196

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: $174 (168%)

Insurance Median: $196 (189%)

Cash: $174 (168% of Medicare)

Ins. Median: $196 (189% 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
Blue Cross Blue Shield	$94 - $269	91%
Community Care	$94	91%
Health Partners	$94 - $196	91%
Humana	$94	91%
Icare	$94	91%
Molina	$94	91%
Network Health Plan	$94 - $190	91%
Priority Health	$94	91%
Quartz	$94	91%
Security Health Plan	$94 - $248	91%
UnitedHealthcare	$94 - $196	91%
Upper Peninsula Health Plan	$94	91%
Centivo	$95 - $104	92%
Aetna	$96 - $205	92%
Wellcare	$96	92%
Care Wisconsin/Mychoice	$97	93%
Medical College Of Wisconsin	$104	100%
Chorus Community Health Plan	$123	119%
Froedtert South	$126	121%
Sheboygan Employers Health Network	$196	189%
Wisconsin Physician Services Statewide Alliance	$199	192%
Trilogy	$205	198%
Health Payment Systems	$208	200%
Cigna	$246	237%
Dean Health Plan	$253	244%
Group Health Cooperative	$253	244%
Healtheos	$253	244%
Multiplan/Private Healthcare Systems	$253	244%
Healthsmart	$262	252%
Wisconsin Physician Services	$269	259%
First Health Network	$273	263%

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 $174.
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 Froedtert Memorial Lutheran 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.