CMS Price Transparency Data

Group therapy session

Facility: Gundersen Lutheran Medical Center

Billing Code: 90853 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90853
Insurance Median: $104
Cash Discount Price: $51
vs. Medicare Baseline: 1.00x Medicare

The contracted insurance negotiated median rate for a Group therapy session at Gundersen Lutheran Medical Center is $104. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $51. Compared to the federal Medicare reimbursement reference rate of $103.79, this hospital’s rate is 1.00x the Medicare baseline. Located in 1910 South Ave, La Crosse, WI.

Cash / Self-Pay

$51

Average discount available for prompt cash payment at this facility.

Insurance Median

$104

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: $51 (49%)

Insurance Median: $104 (100%)

Cash: $51 (49% of Medicare)

Ins. Median: $104 (100% 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	$34 - $166	33%
Medica	$45 - $103	43%
Ucare	$54 - $108	52%
Dean Health Plan	$57	55%
Quartz	$57	55%
Aetna	$59 - $128	57%
Health Partners	$68 - $119	66%
Amerigroup	$85 - $108	82%
Molina Health	$85 - $108	82%
Icare	$92 - $108	89%
Medical Associates	$92 - $101	89%
UnitedHealthcare	$92 - $110	89%
Midland Choice	$101	97%
Alliance	$106 - $113	102%
Claim Doc Llc	$108	104%
Group Health Eau Claire	$108 - $122	104%
Group Health Of South Central	$108	104%
Iowa Total Care	$108	104%
Managed Health Service	$108	104%
Wps Narrow Network	$109	105%
Cigna	$111	107%
Wps - Arise	$111	107%
Aspirus Arise Health	$112	108%
Allied National General	$115	111%
Preferred One	$115	111%
Wps Statewide	$115	111%
Coventry Health Care	$128	123%
Humana	$128	123%
Multiplan/Healtheos	$130	125%

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 $51.
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 Gundersen Lutheran 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.