CMS Price Transparency Data

Group therapy session

Facility: Craig Hospital

Billing Code: 90853 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90853
Insurance Median: $498
Cash Discount Price: $276
vs. Medicare Baseline: 4.80x Medicare

The contracted insurance negotiated median rate for a Group therapy session at Craig Hospital is $498. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $276. Compared to the federal Medicare reimbursement reference rate of $103.79, this hospital’s rate is 4.80x the Medicare baseline. Located in 3425 S Clarkson St, Englewood, CO.

Cash / Self-Pay

$276

Average discount available for prompt cash payment at this facility.

Insurance Median

$498

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: $276 (266%)

Insurance Median: $498 (480%)

Cash: $276 (266% of Medicare)

Ins. Median: $498 (480% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 480% of the Medicare baseline (a markup of 380%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Veterans Administration	$78	75%
Cms	$92	89%
UnitedHealthcare	$92 - $361	89%
Cigna	$366	353%
Kaiser	$376	362%
Blue Cross Blue Shield	$384	370%
Carisk Outcomes	$399	384%
Zenith	$432	416%
Aetna	$452	435%
Corvel Worker'S Comp	$465	448%
Liberty Mutual Worker'S Comp	$465	448%
Paradigm	$465	448%
Rocky Mountain Health Plan	$485	467%
Midwest Employers Casualty	$492	474%
Coventry/First Health	$498	480%
Fcci Worker'S Comp	$498	480%
Geha/Ppo Usa	$498	480%
Great-West Healthcare	$498	480%
Prime Health Services	$505	487%
First Choice Health	$518	499%
Multiplan/Phcs	$525	506%
Focus Worker'S Comp	$531	512%
General Reinsurance	$531 - $565	512%
Provider Network Of America	$531	512%
Three Rivers Provider Network	$531 - $545	512%
Wyoming Worker'S Comp	$531	512%
Allstate	$565	544%
Tricare	$565	544%
National Provider Network	$598	576%
Up & Up	$598	576%

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 $276.
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 Craig 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.