CMS Price Transparency Data

Group therapy session

Facility: Berkshire Medical Center

Billing Code: 90853 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90853
Insurance Median: $88
Cash Discount Price: $136
vs. Medicare Baseline: 0.85x Medicare

The contracted insurance negotiated median rate for a Group therapy session at Berkshire Medical Center is $88. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $136. Compared to the federal Medicare reimbursement reference rate of $103.79, this hospital’s rate is 0.85x the Medicare baseline. Located in 725 North Street, Pittsfield, MA.

Cash / Self-Pay

$136

Average discount available for prompt cash payment at this facility.

Insurance Median

$88

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: $136 (131%)

Insurance Median: $88 (85%)

Cash: $136 (131% of Medicare)

Ins. Median: $88 (85% 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
Fallon	$25 - $154	24%
Workers Comp	$25 - $117	24%
Other Government	$29 - $130	28%
Hospice	$31 - $130	30%
Medicare (plans)	$31 - $128	30%
UnitedHealthcare	$31 - $166	30%
Blue Cross Blue Shield	$32 - $165	31%
Commcare Alliance	$32 - $154	31%
Health New England	$32 - $141	31%
Comm Hne Hmo	$49 - $134	47%
Aetna	$50 - $146	48%
Unicare	$51 - $126	49%
Comm Hne Ppo	$52 - $142	50%
Comm Tufts Qhpsub (Network)	$52 - $117	50%
Point32Health	$52 - $184	50%
Allways Nhp	$60 - $125	58%
Beacon	$79 - $174	76%
Cdphp	$83 - $174	80%
Cigna	$83 - $180	80%
Mvp	$83 - $174	80%
Oxford	$83 - $174	80%
First Health	$86 - $184	83%
Connecticare	$88 - $184	85%
Consolidated Health Plans	$88 - $184	85%
Other Commercial	$88 - $184	85%
Phcs	$88 - $184	85%
Self Pay	$88 - $184	85%
Mbhp	$98	94%
Mcd Out Of State	$98	94%
Medicaid / KanCare	$98	94%
Bmchnp	$128	123%

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 $136.
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 Berkshire 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.