CMS Price Transparency Data

Group therapy session

Facility: Essentia Health St Mary's Medical Center

Billing Code: 90853 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90853
Insurance Median: $93
Cash Discount Price: $106
vs. Medicare Baseline: 0.90x Medicare

The contracted insurance negotiated median rate for a Group therapy session at Essentia Health St Mary's Medical Center is $93. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $106. Compared to the federal Medicare reimbursement reference rate of $103.79, this hospital’s rate is 0.90x the Medicare baseline. Located in 402 East Second Street, Duluth, MN.

Cash / Self-Pay

$106

Average discount available for prompt cash payment at this facility.

Insurance Median

$93

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: $106 (102%)

Insurance Median: $93 (90%)

Cash: $106 (102% of Medicare)

Ins. Median: $93 (90% 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
Medica Access	$53	51%
Healthpartners Care Pmap	$64	62%
Sanford Health Plan	$69 - $164	66%
Blue Cross Blue Shield	$71 - $206	68%
Blue Plus Pmap Pcc Prime	$71 - $80	68%
Primewest	$86	83%
Medica	$88 - $91	85%
Medica Uplan	$88	85%
Itasca Med Care	$92	89%
Advocare/Security Health	$93	90%
Freedom Blue Ppo	$93	90%
Healthpartners Care Msho / Mcr Adv	$93	90%
Imcare Msho (Ref Req)	$93	90%
Imcare Msho Pcc Prime	$93	90%
Imcare Msho Ref Req	$93	90%
Medica Advantage Solutions	$93	90%
Medica Msho/Dual Solutions	$93	90%
Medica Prime Solution Group	$93	90%
Medicare (plans)	$93	90%
Nd Va Administration	$93	90%
Platinum Blue / Vantage Blue	$93	90%
Primewest Msho	$93	90%
Secure Blue Msho	$93	90%
Ubh Cost Plan	$93	90%
Ubh Msho	$93	90%
Ucare Msho	$93	90%
UnitedHealthcare	$93 - $117	90%
Healthpartners	$96 - $114	92%
Medica Choice	$98	94%
Ucare	$105	101%
Cigna	$114	110%
Healthpartners Pcc Prime	$114	110%
Wea	$115 - $123	111%
Security Health	$123	119%
America'S Ppo	$124	119%
Wps	$133 - $134	128%
Aetna	$136	131%
Healthscope Benefits	$136	131%
Healtheos	$138	133%

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 $106.
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 Essentia Health St Mary's 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.