CMS Price Transparency Data

Group therapy session

Facility: M Health Fairview Ridges Hospital

Billing Code: 90853 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90853
Insurance Median: $260
Cash Discount Price: $160
vs. Medicare Baseline: 2.51x Medicare

The contracted insurance negotiated median rate for a Group therapy session at M Health Fairview Ridges Hospital is $260. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $160. Compared to the federal Medicare reimbursement reference rate of $103.79, this hospital’s rate is 2.51x the Medicare baseline. Located in 201 East Nicollet Boulevard, Burnsville, MN.

Cash / Self-Pay

$160

Average discount available for prompt cash payment at this facility.

Insurance Median

$260

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: $160 (154%)

Insurance Median: $260 (251%)

Cash: $160 (154% of Medicare)

Ins. Median: $260 (251% 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 251% of the Medicare baseline (a markup of 151%). 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
Medica	$20 - $109	19%
Blue Cross Blue Shield	$21 - $416	20%
Health Partners	$21 - $208	20%
Itasca Medical Care	$21 - $90	20%
Primewest	$21 - $90	20%
South Country Health Alliance	$21 - $90	20%
Ucare	$21 - $207	20%
Sanford Health Plan	$23 - $430	22%
Security Health Plan	$23 - $548	22%
UnitedHealthcare	$23 - $399	22%
Wellcare	$23 - $90	22%
Hennepin Health	$24 - $93	23%
America'S Ppo	$60 - $526	58%
First Health	$95 - $599	92%
Multiplan	$99 - $620	95%
Private Healthcare Systems	$99 - $620	95%
Wisconsin Physician Services	$104 - $657	100%

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 $160.
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 M Health Fairview Ridges 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.