CMS Price Transparency Data

Group therapy session

Facility: St Mary's Hospital

Billing Code: 90853 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90853
Insurance Median: $27
Cash Discount Price: $21
vs. Medicare Baseline: 0.26x Medicare

The contracted insurance negotiated median rate for a Group therapy session at St Mary's Hospital is $27. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $21. Compared to the federal Medicare reimbursement reference rate of $103.79, this hospital’s rate is 0.26x the Medicare baseline. Located in 701 Lewiston St, Cottonwood, ID.

Cash / Self-Pay

$21

Average discount available for prompt cash payment at this facility.

Insurance Median

$27

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: $21 (20%)

Insurance Median: $27 (26%)

Cash: $21 (20% of Medicare)

Ins. Median: $27 (26% 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	$14 - $46	13%
Aetna	$16 - $44	15%
Medicare (plans)	$16 - $39	15%
Nimiipuu Mcr Adv - Allplans	$16 - $39	15%
Regence Blue Shield Mcr	$16 - $39	15%
Tricare	$16 - $39	15%
UnitedHealthcare	$16 - $49	15%
Veterans Admin - All Plans	$16 - $39	15%
Corizon Correctional - All Plans	$18 - $45	17%
Geha - All Plans	$18 - $46	17%
Idaho Phys Network - All Plans	$18 - $45	17%
Multiplan - All Plans	$18 - $46	17%
First Choice- All Plans	$19 - $46	18%
Regence Blue Shield - All Other Plans	$19 - $47	18%

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 $21.
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 Mary's 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.