CMS Price Transparency Data

Group therapy session

Facility: El Dorado Springs

Billing Code: 90853 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90853
Insurance Median: $293
Cash Discount Price: $282
vs. Medicare Baseline: 2.82x Medicare

The contracted insurance negotiated median rate for a Group therapy session at El Dorado Springs is $293. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $282. Compared to the federal Medicare reimbursement reference rate of $103.79, this hospital’s rate is 2.82x the Medicare baseline. Located in 1400 North Wilmot Road, Tucson, AZ.

Cash / Self-Pay

$282

Average discount available for prompt cash payment at this facility.

Insurance Median

$293

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: $282 (272%)

Insurance Median: $293 (282%)

Cash: $282 (272% of Medicare)

Ins. Median: $293 (282% 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 282% of the Medicare baseline (a markup of 182%). 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	$160 - $296	154%
Care 1St	$160 - $376	154%
First Health	$187	180%
Zelis	$190	183%
Multiplan/Phcs/Beech Street	$198	191%
Az Complete Health	$200 - $296	193%
Aetna	$235	226%
Provider Networks Of America	$248	239%
Velocity National Provider Network	$248 - $311	239%
Cigna	$260	251%
Beacon	$276 - $286	266%
Magellan	$291	280%
Humana	$296 - $350	285%
Va Ccn	$296	285%
First Choice Health Network	$350 - $530	337%
Mines & Associates	$350	337%
American Behavioral	$375	361%
Seven Corners	$399	384%
Behavioral Health System	$403	388%
6Degrees Health	$710	684%

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 $282.
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 El Dorado Springs 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.