CMS Price Transparency Data

Group therapy session

Facility: Forks Community Hospital

Billing Code: 90853 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90853
Insurance Median: $28
Cash Discount Price: $40
vs. Medicare Baseline: 0.27x Medicare

The contracted insurance negotiated median rate for a Group therapy session at Forks Community Hospital is $28. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $40. Compared to the federal Medicare reimbursement reference rate of $103.79, this hospital’s rate is 0.27x the Medicare baseline. Located in 530 Bogachiel Way, Forks, WA.

Cash / Self-Pay

$40

Average discount available for prompt cash payment at this facility.

Insurance Median

$28

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: $40 (39%)

Insurance Median: $28 (27%)

Cash: $40 (39% of Medicare)

Ins. Median: $28 (27% 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 (Mco) Mcd-All Plans	$16 - $22	15%
Medicaid / KanCare	$16 - $22	15%
UnitedHealthcare	$16 - $34	15%
Humana	$25 - $27	24%
Molina Commercial-All Other Plans	$25 - $55	24%
Tricare	$25	24%
Triwest-All Plans	$25 - $27	24%
Va-Ihs - All Plans	$25	24%
Community Health Network Mcr-All Other Plans	$27 - $28	26%
Medicare (plans)	$28 - $318	27%
Ambetter / Centene	$29 - $31	28%
Wellcare Med Adv - All Plans	$29 - $31	28%
Blue Cross Blue Shield	$31 - $57	30%
Cigna	$33 - $60	32%
Community Health Exchange	$33 - $39	32%
First Choice-All Plans	$33 - $60	32%
Regence-All Other Plans	$35 - $41	34%
Aetna	$39 - $57	38%

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 $40.
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 Forks Community 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.