CMS Price Transparency Data

Group therapy session

Facility: Primary Children's Hospital

Billing Code: 90853 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90853
Insurance Median: $89
Cash Discount Price: $94
vs. Medicare Baseline: 0.86x Medicare

The contracted insurance negotiated median rate for a Group therapy session at Primary Children's Hospital is $89. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $94. Compared to the federal Medicare reimbursement reference rate of $103.79, this hospital’s rate is 0.86x the Medicare baseline. Located in 100 North Mario Capecchi Drive, Salt Lake City, UT.

Cash / Self-Pay

$94

Average discount available for prompt cash payment at this facility.

Insurance Median

$89

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: $94 (91%)

Insurance Median: $89 (86%)

Cash: $94 (91% of Medicare)

Ins. Median: $89 (86% 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
UnitedHealthcare	$6 - $105	6%
American Health	$23 - $71	22%
Health Plan Of Nevada	$23 - $45	22%
Healthy U	$23 - $59	22%
Molina	$23 - $105	22%
Selecthealth	$23 - $105	22%
Southwest Behavioral Health	$23 - $81	22%
Donor Connect	$45 - $50	43%
Aetna	$89 - $106	86%
Awh Connected	$89 - $106	86%
Byu Athletics	$89 - $105	86%
Campbell Scientific	$89 - $105	86%
Cigna	$89 - $105	86%
Deseret Mutual	$89 - $105	86%
Emi	$89 - $105	86%
Emi Health	$89 - $105	86%
First Choice	$89 - $105	86%
First Choice Of The Midwest	$89 - $105	86%
Franklin County	$89 - $105	86%
Global Excel	$89 - $105	86%
Health Utah	$89 - $105	86%
Humana	$89 - $105	86%
Hygeia Corporation	$89 - $105	86%
Ifit	$89 - $105	86%
Juniper Systems	$89 - $105	86%
Lw Miller	$89 - $105	86%
Managed Care Admin	$89 - $105	86%
Medcare International	$89 - $105	86%
Motivhealth	$89 - $105	86%
Pehp	$89 - $105	86%
Prodegi Corp Benefit	$89 - $105	86%
Tanner Llc	$89 - $105	86%
Tricare	$89	86%
Triwest	$89	86%
Uofu	$89 - $105	86%
Utah Tech	$89 - $105	86%
Wise Network	$89 - $105	86%
First Health	$90 - $106	87%
Blue Cross Blue Shield	$91 - $107	88%
Springtide	$91 - $107	88%
Utah Behavioral Health Network	$101	97%
Altius Mhnet Behavioral Health	$110	106%

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 $94.
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 Primary Children's 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.