CMS Price Transparency Data

Group therapy session

Facility: Eastern Idaho Regional Medical Center

Billing Code: 90853 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90853
Insurance Median: $449
Cash Discount Price: $598
vs. Medicare Baseline: 4.33x Medicare

The contracted insurance negotiated median rate for a Group therapy session at Eastern Idaho Regional Medical Center is $449. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $598. Compared to the federal Medicare reimbursement reference rate of $103.79, this hospital’s rate is 4.33x the Medicare baseline. Located in 3100 Channing Way, Idaho Falls, ID.

Cash / Self-Pay

$598

Average discount available for prompt cash payment at this facility.

Insurance Median

$449

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: $598 (576%)

Insurance Median: $449 (433%)

Cash: $598 (576% of Medicare)

Ins. Median: $449 (433% 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 433% of the Medicare baseline (a markup of 333%). 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
Blue Cross Blue Shield	$24 - $1,996	23%
Molina	$24	23%
Aetna	$35 - $1,023	34%
Doug Andrus Distributing	$36 - $840	35%
Pacificsource Health	$38 - $1,126	37%
Mountain Health Co-Op	$45 - $1,576	43%
Cigna	$49 - $1,156	47%
United	$52 - $1,214	50%
First Choice Health Of Washington	$54 - $1,261	52%
Moda	$56 - $1,309	54%
Prime Health	$67 - $1,786	65%
Geha Ppo Usa	$72 - $1,681	69%
Humana	$76 - $1,765	73%
Multiplan	$76 - $1,891	73%
First Choice Of The Midwest	$81 - $1,891	78%
Interwest Health	$81 - $1,891	78%
St. John'S Health Network	$81 - $1,891	78%
Coventry First Health	$82 - $1,912	79%
Shashone-Bannock Tribal Health	$90 - $2,101	87%
Regence	$232	224%

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 $598.
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 Eastern Idaho Regional 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.