CMS Price Transparency Data

Group therapy session

Facility: Prov Sacred Hrt Med Ctr & Childs Hosp.

Billing Code: 90853 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90853
Insurance Median: $204
Cash Discount Price: $258
vs. Medicare Baseline: 1.97x Medicare

The contracted insurance negotiated median rate for a Group therapy session at Prov Sacred Hrt Med Ctr & Childs Hosp. is $204. 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 1.97x the Medicare baseline. Located in 101 West 8Th Avenue, Spokane, WA.

Cash / Self-Pay

$258

Average discount available for prompt cash payment at this facility.

Insurance Median

$204

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: $204 (197%)

Cash: $258 (249% of Medicare)

Ins. Median: $204 (197% 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
Kaiser	$113 - $285	109%
Aetna	$117 - $118	113%
UnitedHealthcare	$119 - $376	115%
Blue Shield	$122 - $235	118%
Community Health Plan	$125	120%
Cigna	$136	131%
Blue Cross Blue Shield	$179 - $231	172%
Molina	$191	184%
Coordinated Care	$209	201%
First Choice	$283	273%
Providence Health Plan	$288	277%

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 Prov Sacred Hrt Med Ctr & Childs Hosp. 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.