CMS Price Transparency Data

Group therapy session

Facility: Adventist Health Sonora

Billing Code: 90853 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90853
Insurance Median: $35
Cash Discount Price: $12
vs. Medicare Baseline: 0.34x Medicare

The contracted insurance negotiated median rate for a Group therapy session at Adventist Health Sonora is $35. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $12. Compared to the federal Medicare reimbursement reference rate of $103.79, this hospital’s rate is 0.34x the Medicare baseline. Located in 1000 Greenley Road, Sonora, CA.

Cash / Self-Pay

$12

Average discount available for prompt cash payment at this facility.

Insurance Median

$35

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: $12 (12%)

Insurance Median: $35 (34%)

Cash: $12 (12% of Medicare)

Ins. Median: $35 (34% 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
Bc Mcal	$24	23%
Celtic Ca Hlth Well Mcal - All Plans	$24	23%
Central Ca Alliance Mcal	$24	23%
Healthnet Mcal	$24	23%
Medi-Cal	$24	23%
Blue Shield Mcare	$25	24%
Central Ca Alliance Mcr Adv Profee Only	$25	24%
Healthnet Mcr Adv	$25	24%
Tricare	$25	24%
UnitedHealthcare	$25 - $62	24%
Ah Employee Health Plan - All Plans	$27	26%
Cigna	$30	29%
Greatwest Oa/Pos/Hmo	$32	31%
Greatwest Ppo - All Other Plans	$32	31%
Western Growers/Pinnacle - All Plans	$34	33%
Central Ca Alliance Ccs Mcal	$36	35%
Central Ca Alliance Comm Profee Only-All Other Pla	$36	35%
Healthnet - All Other Plans	$36	35%
Central Ca Alliance Chdp Mcal	$48	46%
Aetna	$63	61%
Bc Mcs	$64	62%
Bc Non-Mcs - All Other Plans	$64	62%
Blue Shield Epn	$64	62%
Beech Street- All Plans	$65	63%
Trpn - Three Rivers Ppo - All Plans	$65	63%
Blue Shield - All Other Plans	$68	66%

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 $12.
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 Sonora 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.