CMS Price Transparency Data

Group therapy session

Facility: Stoughton Hospital

Billing Code: 90853 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90853
Insurance Median: $450
Cash Discount Price: $416
vs. Medicare Baseline: 4.34x Medicare

The contracted insurance negotiated median rate for a Group therapy session at Stoughton Hospital is $450. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $416. Compared to the federal Medicare reimbursement reference rate of $103.79, this hospital’s rate is 4.34x the Medicare baseline. Located in 900 Ridge St, Stoughton, WI.

Cash / Self-Pay

$416

Average discount available for prompt cash payment at this facility.

Insurance Median

$450

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: $416 (401%)

Insurance Median: $450 (434%)

Cash: $416 (401% of Medicare)

Ins. Median: $450 (434% 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 434% of the Medicare baseline (a markup of 334%). 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
Tricare	$180	173%
Healthnet Mcr Adv - All Plans	$201	194%
Dean Health Insurance Med Adv	$212	204%
Humana	$212 - $681	204%
Quartz Mcr Adv	$212	204%
Security Health/First Health - All Plans	$212	204%
Aetna	$227 - $643	219%
Medicaid / KanCare	$289	278%
UnitedHealthcare	$333	321%
Alliance - All Plans	$439	423%
Quartz Health Solutions - All Other Lans	$462	445%
Dean Health Insurance Epo	$467	450%
Dean Health Insurance Comm - All Other Plans	$567	546%
Geha - All Plans	$568	547%
Cigna	$606	584%
Wisconsin Ppo Ppa Direct - All Plans	$606	584%
Blue Cross Blue Shield	$659	635%
Wps - All Plans	$681	656%

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 $416.
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 Stoughton 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.