CMS Price Transparency Data

Group therapy session

Facility: Sanford Usd Medical Center

Billing Code: 90853 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90853
Insurance Median: $111
Cash Discount Price: $213
vs. Medicare Baseline: 1.07x Medicare

The contracted insurance negotiated median rate for a Group therapy session at Sanford Usd Medical Center is $111. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $213. Compared to the federal Medicare reimbursement reference rate of $103.79, this hospital’s rate is 1.07x the Medicare baseline. Located in 1305 W 18Th St Post Office Box 5039, Sioux Falls, SD.

Cash / Self-Pay

$213

Average discount available for prompt cash payment at this facility.

Insurance Median

$111

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: $213 (205%)

Insurance Median: $111 (107%)

Cash: $213 (205% of Medicare)

Ins. Median: $111 (107% 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
Sanford Health Plan	$24	23%
Blue Cross Blue Shield	$40 - $112	39%
Sanford Health Plan Align	$88	85%
Health Partners	$89 - $104	86%
Primewest	$93 - $97	90%
Ucare	$93 - $187	90%
Aetna	$95 - $203	92%
Medicare (plans)	$95	92%
UnitedHealthcare	$95 - $234	92%
Security Health Plan	$146	141%
Medica	$179 - $192	172%
First Choice Health Network	$239	230%
Healthez	$239	230%
Multiplan	$239	230%

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 $213.
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 Sanford Usd 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.