CMS Price Transparency Data

Group therapy session

Facility: West Valley Medical Center

Billing Code: 90853 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90853
Insurance Median: $231
Cash Discount Price: $320
vs. Medicare Baseline: 2.23x Medicare

The contracted insurance negotiated median rate for a Group therapy session at West Valley Medical Center is $231. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $320. Compared to the federal Medicare reimbursement reference rate of $103.79, this hospital’s rate is 2.23x the Medicare baseline. Located in 1717 Arlington Street, Caldwell, ID.

Cash / Self-Pay

$320

Average discount available for prompt cash payment at this facility.

Insurance Median

$231

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: $320 (308%)

Insurance Median: $231 (223%)

Cash: $320 (308% of Medicare)

Ins. Median: $231 (223% 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 223% of the Medicare baseline (a markup of 123%). 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	$24 - $304	23%
Molina	$24	23%
Corizon Health	$118	114%
True Blue	$126	121%
Cigna	$179	172%
Pacificsource Health	$191	184%
United	$191	184%
Moda	$199	192%
St Luke'S Health Partners	$208	200%
Regence	$231	223%
Aetna	$253	244%
Four Rivers Hospice	$256	247%
Multiplan	$256	247%
Humana	$269	259%
Geha Ppo Usa	$272	262%
Coventry First Health	$288	277%
St Alphonsus Health	$288	277%

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 $320.
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 West Valley Medical Center 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.