CMS Price Transparency Data

Group therapy session

Facility: Adventist Health Vallejo

Billing Code: 90853 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90853
Insurance Median: $337
Cash Discount Price: $93
vs. Medicare Baseline: 3.25x Medicare

The contracted insurance negotiated median rate for a Group therapy session at Adventist Health Vallejo is $337. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $93. Compared to the federal Medicare reimbursement reference rate of $103.79, this hospital’s rate is 3.25x the Medicare baseline. Located in 525 Oregon St, Vallejo, CA.

Cash / Self-Pay

$93

Average discount available for prompt cash payment at this facility.

Insurance Median

$337

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: $93 (90%)

Insurance Median: $337 (325%)

Cash: $93 (90% of Medicare)

Ins. Median: $337 (325% 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 325% of the Medicare baseline (a markup of 225%). 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
Medi-Cal	$24	23%
Va Medi-Cal	$24	23%
Blue Shield Mcr Adv	$92	89%
Medicare (plans)	$92	89%
Napa County Mcal Child	$92	89%
Tricare	$92	89%
Va Mcr-All Other Plans	$92	89%
Ah Employee Health Plan-All Plans	$166	160%
Blue Shield Behav Hlth	$280	270%
Blue Shield Non-Epn-All Other Plans	$289	278%
Blue Shield Epn	$293	282%
Aetna	$324	312%
Cigna	$331 - $661	319%
Phcs-All Plans	$343	330%
Western Growers-All Plans	$361	348%
Healthnet-All Plans	$382	368%
Interplan-All Plans	$405	390%
Choicecare-All Plans	$436	420%
Blue Cross Blue Shield	$459	442%
Beech Street-All Plans	$467	450%
Kaiser-All Plans	$523	504%
Health Management Network-All Plans	$530	511%
Galaxy Network-All Plans	$561	541%
Three Rivers-All Plans	$561	541%

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 $93.
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 Vallejo 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.