CMS Price Transparency Data

Group therapy session

Facility: Valley Children's Hospital

Billing Code: 90853 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90853
Insurance Median: $141
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.36x Medicare

The contracted insurance negotiated median rate for a Group therapy session at Valley Children's Hospital is $141. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $103.79, this hospital’s rate is 1.36x the Medicare baseline. Located in 9300 Valley Childrens Place, Madera, CA.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$141

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%)

Insurance Median: $141 (136%)

Ins. Median: $141 (136% 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
Allcare Ipa	$4	4%
Community Care Ipa	$4 - $6	4%
Kaiser	$4 - $178	4%
Central Valley Medical Providers Ipa	$6 - $137	6%
Dignity Ipa_Formerly Img	$6	6%
La Salle Ipa	$6	6%
Sante Ipa	$6	6%
Sequoia Health Ipa	$6	6%
United Physicians Network Ipa	$6	6%
Univseral Healthcare Ipa	$6	6%
Adventist	$7	7%
Blue Cross Blue Shield	$7 - $156	7%
Cencal Health	$8	8%
Kern Family Health Care	$8	8%
Health Net	$96 - $179	92%
Blue Shield	$132	127%
Dignity Health Central Coast	$136	131%
Community Care Health Plan	$141	136%
Community Health	$151	145%
Stanislaus Partners In Health	$151	145%
Physicians Choice Medical Group	$153	147%
Health Plan Of San Joaquin	$164	158%
Fowler Packing	$170	164%
Dignity (Formerly Managed Care Systems)	$173	167%
Kern Legacy	$178	172%
UnitedHealthcare	$183 - $195	176%
Aetna	$184	177%
First Health Formerly Coventry	$203	196%
Bakersfield Family Medical Group	$206	198%
Network By Design	$212	204%
Health Smart	$219	211%
Key Medical Ipa	$219	211%
Sutter Health	$233	224%
Multiplan	$262	252%

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 $X.
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 Valley Children's 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.