CMS Price Transparency Data

Group therapy session

Facility: University of Iowa Health Care Medical Center Down

Billing Code: 90853 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90853
Insurance Median: $87
Cash Discount Price: $94
vs. Medicare Baseline: 0.84x Medicare

The contracted insurance negotiated median rate for a Group therapy session at University of Iowa Health Care Medical Center Down is $87. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $94. Compared to the federal Medicare reimbursement reference rate of $103.79, this hospital’s rate is 0.84x the Medicare baseline. Located in 500 E Market Street, Iowa City, IA.

Cash / Self-Pay

$94

Average discount available for prompt cash payment at this facility.

Insurance Median

$87

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: $94 (91%)

Insurance Median: $87 (84%)

Cash: $94 (91% of Medicare)

Ins. Median: $87 (84% 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
Aetna	$24 - $87	23%
Blue Cross Blue Shield	$24 - $88	23%
Healthpartners	$24 - $114	23%
Iowa Total Care	$24 - $91	23%
Medical Associates	$24 - $106	23%
Molina Healthcare	$24 - $54	23%
UnitedHealthcare	$24 - $170	23%
Wellpoint (Amerigroup)	$25 - $91	24%
Immergrun	$33 - $34	32%
Aplos Health Plan	$60 - $107	58%
Quad City Community Healthcare	$62 - $100	60%
Midlands Choice	$70 - $109	67%
Oscar Health	$84	81%
Great River Health Systems	$93 - $94	90%
Sedgwick	$106 - $107	102%
Global Excel	$113 - $114	109%
Sanford Health Plan	$113 - $114	109%
Sisco	$117 - $118	113%
Employee Benefit Systems	$118 - $121	114%
Healthsmart	$120 - $121	116%
Hfn	$122 - $123	118%
Multiplan	$122 - $123	118%

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 $94.
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 University of Iowa Health Care Medical Center Down 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.