CMS Price Transparency Data

Group therapy session

Facility: Black River Memorial Hospital

Billing Code: 90853 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90853
Insurance Median: $36
Cash Discount Price: $20
vs. Medicare Baseline: 0.35x Medicare

The contracted insurance negotiated median rate for a Group therapy session at Black River Memorial Hospital is $36. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $20. Compared to the federal Medicare reimbursement reference rate of $103.79, this hospital’s rate is 0.35x the Medicare baseline. Located in 711 W Adams St, Black River Falls, WI.

Cash / Self-Pay

$20

Average discount available for prompt cash payment at this facility.

Insurance Median

$36

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: $20 (19%)

Insurance Median: $36 (35%)

Cash: $20 (19% of Medicare)

Ins. Median: $36 (35% 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	$11 - $61	11%
Humana	$11 - $57	11%
My Choice Wisconsin, Inc.	$11 - $75	11%
Quartz Health Solutions, Inc	$11 - $75	11%
Security Health Plan	$11 - $51	11%
UnitedHealthcare	$11 - $61	11%
Corvel	$13 - $37	13%
The Alliance	$19 - $52	18%
Triology Health Solutions	$20 - $58	19%
Association Benefits Solution	$21 - $58	20%
Cigna	$21 - $59	20%
Cofinity	$21 - $59	20%
Coventry Health Care	$21 - $59	20%
Custom Benefit Administrators	$21 - $59	20%
Family Health Center Of Marshfield	$21 - $58	20%
First Health Group Corporation	$21 - $58	20%
Group Health Cooperative Of Eau Claire	$21 - $61	20%
Healthpartners, Inc.	$21 - $59	20%
Medica	$21 - $57	20%
Multiplan	$21 - $61	20%
Provider Network Of America	$21 - $58	20%
Wisconsin Physicians Service Insurance Corp	$21 - $59	20%
Chorus	$22 - $60	21%
Inclusa	$28 - $75	27%
Managed Health Services Insurance Corp	$28 - $61	27%

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 $20.
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 Black River 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.