CMS Price Transparency Data

Group therapy session

Facility: Childrens Hospital of Wisconsin

Billing Code: 90853 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90853
Insurance Median: $103
Cash Discount Price: $67
vs. Medicare Baseline: 0.99x Medicare

The contracted insurance negotiated median rate for a Group therapy session at Childrens Hospital of Wisconsin is $103. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $67. Compared to the federal Medicare reimbursement reference rate of $103.79, this hospital’s rate is 0.99x the Medicare baseline. Located in 9000 W Wisconsin Ave, Milwaukee, WI.

Cash / Self-Pay

$67

Average discount available for prompt cash payment at this facility.

Insurance Median

$103

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: $67 (65%)

Insurance Median: $103 (99%)

Cash: $67 (65% of Medicare)

Ins. Median: $103 (99% 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
Froedtert Health	$85 - $103	82%
Medical College Of Wisconsin	$85	82%
Network Health Plan	$87	84%
UnitedHealthcare	$89 - $92	86%
Aspirus Health Plan	$91	88%
Common Ground Healthcare Cooperative	$91 - $103	88%
Trilogy Health Solutions	$91 - $103	88%
Wps Health Plan	$92 - $109	89%
Advocate Aurora Healthcare	$94	91%
Blue Cross Blue Shield	$95 - $115	92%
Centivo	$95	92%
Employer Health Care Alliance Cooperative	$95	92%
Health Partners	$95 - $107	92%
Dean Health Plan	$97	93%
Group Health Cooperative Of Eau Claire	$97	93%
Oan Llc	$97	93%
Security Health Plan	$101	97%
Health Payment Systems	$103	99%
Praire States	$103	99%
Quartz Health Insurance	$103	99%
Sheboygan Employer'S Health Network	$103	99%
Mayo Clinic Health Solutions	$106	102%
Aetna	$107 - $108	103%
Bellin Thedacare	$109	105%
Cigna	$109	105%
Group Health Cooperative Of South Central Wisconsin	$109	105%
Prevea Health Network	$109	105%
Multiplan	$111 - $115	107%
Coventry Health Care	$115	111%

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 $67.
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 Childrens Hospital of Wisconsin 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.