CMS Price Transparency Data

Group therapy session

Facility: Adventist Health St Helena

Billing Code: 90853 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90853
Insurance Median: $405
Cash Discount Price: $105
vs. Medicare Baseline: 3.90x Medicare

The contracted insurance negotiated median rate for a Group therapy session at Adventist Health St Helena is $405. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $105. Compared to the federal Medicare reimbursement reference rate of $103.79, this hospital’s rate is 3.90x the Medicare baseline. Located in 10 Woodland Road, Saint Helena, CA.

Cash / Self-Pay

$105

Average discount available for prompt cash payment at this facility.

Insurance Median

$405

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: $105 (101%)

Insurance Median: $405 (390%)

Cash: $105 (101% of Medicare)

Ins. Median: $405 (390% 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 390% of the Medicare baseline (a markup of 290%). 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
Va Medi-Cal	$24	23%
Blue Shield Bh Mcr Adv	$135	130%
Blue Shield Mcr Adv	$135	130%
Kaiser Mcr Adv	$135	130%
Tricare	$135	130%
Va Mcr - All Other Plans	$135	130%
Ah Employee Health Plan - All Plans	$243	234%
Blue Shield Behav Hlth	$314	303%
Blue Shield Non-Epn	$324	312%
Blue Shield Epn-All Other Plans	$329	317%
Cigna	$331 - $661	319%
Aetna	$363	350%
Phcs-All Plans	$384	370%
Western Growers-All Plans	$405	390%
Healthnet-All Plans	$428	412%
Interplan-All Plans	$454	437%
Blue Cross Blue Shield	$463 - $514	446%
Choicecare-All Plans	$489	471%
Beech Street-All Plans	$524	505%
Kaiser-All Other Plans	$572	551%
Health Management Network-All Plans	$593	571%
Galaxy Network-All Plans	$628	605%
Three Rivers-All Plans	$628	605%

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 $105.
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 Adventist Health St Helena 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.