CMS Price Transparency Data

Group therapy session

Facility: Valley West Community Hospital

Billing Code: 90853 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90853
Insurance Median: $75
Cash Discount Price: $84
vs. Medicare Baseline: 0.72x Medicare

The contracted insurance negotiated median rate for a Group therapy session at Valley West Community Hospital is $75. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $84. Compared to the federal Medicare reimbursement reference rate of $103.79, this hospital’s rate is 0.72x the Medicare baseline. Located in 11 East Pleasant Avenue, Sandwich, IL.

Cash / Self-Pay

$84

Average discount available for prompt cash payment at this facility.

Insurance Median

$75

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: $84 (81%)

Insurance Median: $75 (72%)

Cash: $84 (81% of Medicare)

Ins. Median: $75 (72% 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
Blue Cross Blue Shield	$22 - $99	21%
Global Excel [1712]	$22 - $23	21%
Humana	$22 - $23	21%
Aetna	$30 - $84	29%
Cigna	$53 - $58	51%
Health'S Finest Network [126]	$53 - $103	51%
UnitedHealthcare	$59 - $121	57%
The Alliance [1703]	$64 - $66	62%
Choicecare [177]	$80 - $82	77%
Healthlink [125]	$88 - $91	85%
Multiplan/Phcs [142]	$94 - $121	91%
First Health Plan [6034]	$118 - $121	114%

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 $84.
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 West Community 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.