CMS Price Transparency Data

Group therapy session

Facility: North Adams Regional Hospital Corporation

Billing Code: 90853 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90853
Insurance Median: $83
Cash Discount Price: $136
vs. Medicare Baseline: 0.80x Medicare

The contracted insurance negotiated median rate for a Group therapy session at North Adams Regional Hospital Corporation is $83. 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 0.80x the Medicare baseline. Located in 71 Hospital Avenue, North Adams, MA.

Cash / Self-Pay

$136

Average discount available for prompt cash payment at this facility.

Insurance Median

$83

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: $83 (80%)

Cash: $136 (131% of Medicare)

Ins. Median: $83 (80% 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
Medicaid / KanCare	$21 - $198	20%
Wc Workers Comp	$25 - $117	24%
Blue Cross Blue Shield	$27 - $165	26%
Mcrmanaged Cca One Care	$27 - $44	26%
Medicare (plans)	$27 - $45	26%
Comm Hospice	$28 - $45	27%
Mcr Miscellaneous	$28 - $45	27%
Mcrmanaged Usa Family	$28 - $45	27%
Mcrmanaged Va	$28 - $45	27%
Tricare	$29 - $73	28%
Oth United Vaccn	$31	30%
Comm Fallon Qhp	$37 - $110	36%
Comm Hne Hmo	$49 - $134	47%
Aetna	$50 - $146	48%
Comm Unicare	$51 - $126	49%
Comm Hne	$52 - $141	50%
Comm Hne Ppo	$52 - $142	50%
Comm Network Qhpsub	$52 - $117	50%
Mcdmanaged Network	$52 - $118	50%
Comm Network Qhpnonsub	$59 - $139	57%
Comm Nhp	$60 - $125	58%
Comm Tufts	$73 - $153	70%
UnitedHealthcare	$80 - $166	77%
Cigna	$83 - $180	80%
Comm Cdphp	$83 - $174	80%
Comm Mvp	$83 - $174	80%
Comm Oxford	$83 - $174	80%
Comm First Health	$86 - $184	83%
Comm Connecticare	$88 - $184	85%
Comm Consolidated Health	$88 - $184	85%
Comm Harvard	$88 - $184	85%
Comm Other	$88 - $184	85%
Comm Phcs	$88 - $184	85%
Comm Self Pay	$88 - $184	85%
Mcd New York	$98	94%
Mcd Masshealth	$198	191%
Mcd Out Of State	$198	191%
Mcdmanaged Cdphp	$198	191%
Mcdmanaged Hne Mcdaco	$198	191%
Mcdmanaged Bmchnp	$206	198%

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 North Adams Regional Hospital Corporation 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.