CMS Price Transparency Data

Group therapy session

Facility: St Lukes Regional Medical Center

Billing Code: 90853 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90853
Insurance Median: $95
Cash Discount Price: $464
vs. Medicare Baseline: 0.92x Medicare

The contracted insurance negotiated median rate for a Group therapy session at St Lukes Regional Medical Center is $95. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $464. Compared to the federal Medicare reimbursement reference rate of $103.79, this hospital’s rate is 0.92x the Medicare baseline. Located in 2720 Stone Park Boulevard, Sioux City, IA.

Cash / Self-Pay

$464

Average discount available for prompt cash payment at this facility.

Insurance Median

$95

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: $464 (447%)

Insurance Median: $95 (92%)

Cash: $464 (447% of Medicare)

Ins. Median: $95 (92% 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
Nebraska Total Care	$20 - $226	19%
Aetna	$24 - $226	23%
Blue Cross Blue Shield	$24 - $92	23%
Molina	$24 - $92	23%
Amerivantage	$25 - $95	24%
Humana	$25 - $95	24%
UnitedHealthcare	$25 - $247	24%
Health Partners Open Network	$35 - $138	34%
Wellmark Uph Self-Funded	$35	34%
Avera Health Plan	$36 - $565	35%
Cigna	$60 - $547	58%
Amerigroup	$82	79%
Iowa Total Care	$82	79%
Medica Exchange Inspire	$150 - $449	145%
Medica Exchange Insure	$168 - $503	162%

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 $464.
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 St Lukes Regional Medical Center 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.