CMS Price Transparency Data

Group therapy session

Facility: Kootenai Health

Billing Code: 90853 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90853
Insurance Median: $153
Cash Discount Price: $209
vs. Medicare Baseline: 1.47x Medicare

The contracted insurance negotiated median rate for a Group therapy session at Kootenai Health is $153. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $209. Compared to the federal Medicare reimbursement reference rate of $103.79, this hospital’s rate is 1.47x the Medicare baseline. Located in 2003 Kootenai Health Way, Coeur D'Alene, ID.

Cash / Self-Pay

$209

Average discount available for prompt cash payment at this facility.

Insurance Median

$153

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: $209 (201%)

Insurance Median: $153 (147%)

Cash: $209 (201% of Medicare)

Ins. Median: $153 (147% 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
Coordinated Care Of Washington	$14	13%
Molina Healthcare Of Idaho	$14 - $114	13%
Molina Healthcare Of Washington	$14	13%
Blue Cross Blue Shield	$24 - $276	23%
Humana	$24 - $105	23%
Magellan	$24	23%
Pacificsource	$24 - $251	23%
Premera	$24 - $190	23%
Regence Blue Shield Of Idaho	$24 - $105	23%
UnitedHealthcare	$24 - $276	23%
Wellpoint	$24	23%
Aetna	$25 - $255	24%
Group Health/Kaiser	$32 - $378	31%
Mountain Health Co-Op	$193 - $238	186%
Cigna	$204 - $255	197%
First Choice Health (Ameriben)	$212 - $266	204%
Interwest Health	$212 - $261	204%

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 $209.
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 Kootenai Health 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.