CMS Price Transparency Data

Group therapy session

Facility: Medstar Washington Hospital Center

Billing Code: 90853 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90853
Insurance Median: $256
Cash Discount Price: $258
vs. Medicare Baseline: 2.47x Medicare

The contracted insurance negotiated median rate for a Group therapy session at Medstar Washington Hospital Center is $256. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $258. Compared to the federal Medicare reimbursement reference rate of $103.79, this hospital’s rate is 2.47x the Medicare baseline. Located in 110 Irving Street Nw, Washington, DC.

Cash / Self-Pay

$258

Average discount available for prompt cash payment at this facility.

Insurance Median

$256

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: $258 (249%)

Insurance Median: $256 (247%)

Cash: $258 (249% of Medicare)

Ins. Median: $256 (247% 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 247% of the Medicare baseline (a markup of 147%). 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
UnitedHealthcare	$115 - $121	111%
Carefirst Advantage Inc	$120	116%
Tricare	$120	116%
Aetna	$124 - $254	119%
Health Care Service Corporation	$126	121%
Humana	$126	121%
Kaiser Permanente	$126 - $477	121%
Medstar Family Choice Inc	$191 - $544	184%
Cigna	$237	228%
Carefirst Blue Choice Inc	$258 - $263	249%
Pfc	$258	249%
Ncppo Healthlink Ppo	$298	287%
Private Healthcare Systems (Phcs)	$318	306%
First Health	$338	326%
Amerigroup	$544	524%
Amerihealth Caritas District Of Columbia	$544	524%
Hscsn	$544	524%

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 $258.
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 Medstar Washington Hospital 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.