CMS Price Transparency Data

Group therapy session

Facility: Sherman Oaks Hospital

Billing Code: 90853 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90853
Insurance Median: $130
Cash Discount Price: $130
vs. Medicare Baseline: 1.25x Medicare

The contracted insurance negotiated median rate for a Group therapy session at Sherman Oaks Hospital is $130. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $130. Compared to the federal Medicare reimbursement reference rate of $103.79, this hospital’s rate is 1.25x the Medicare baseline. Located in 4929 Van Nuys Blvd, Sherman Oaks, CA.

Cash / Self-Pay

$130

Average discount available for prompt cash payment at this facility.

Insurance Median

$130

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: $130 (125%)

Insurance Median: $130 (125%)

Cash: $130 (125% of Medicare)

Ins. Median: $130 (125% 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	$5	5%
Aids Healthcare Foundation	$21 - $133	20%
Blue Shield Of Promise	$21	20%
Health Net Of Ca	$21 - $190	20%
L.A Care Health Plan	$21 - $130	20%
Molina	$21 - $130	20%
Traditional Medi-Cal	$21	20%
Blue Shield Of Ca, Va	$26	25%
Alignment	$130	125%
Elite Health Plan	$130	125%
Imperial Health Plan	$130	125%
Managed Health Network	$130	125%
Medicare (plans)	$130	125%
Renal Payer Solutions	$130	125%
Tricare	$130	125%
Usa Senior Care Network	$130	125%
Brand New Day	$131 - $195	126%
Corvel	$148	143%
Zelis Healthcare	$148	143%
Americas Choice Provider Network	$151	145%
Multiplan	$151	145%
Prime Health Services	$151	145%
Three Rivers	$151	145%
Healthsmart Preferred Network	$153	147%
Provider Select	$154	148%
Provider Network Of America	$156	150%
Aetna	$166	160%
Ca Foundation For Medical Center	$171	165%
Worker Comp	$171	165%
Employer Direct Healthcare	$182	175%
Naphcare	$202	195%
Beacon Health Strategies	$275	265%

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 $130.
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 Sherman Oaks 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.