CMS Price Transparency Data

Group therapy session

Facility: Tri Valley Health System

Billing Code: 90853 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90853
Insurance Median: $563
Cash Discount Price: $730
vs. Medicare Baseline: 5.42x Medicare

The contracted insurance negotiated median rate for a Group therapy session at Tri Valley Health System is $563. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $730. Compared to the federal Medicare reimbursement reference rate of $103.79, this hospital’s rate is 5.42x the Medicare baseline. Located in 1305 West Highway 6/34, Cambridge, NE.

Cash / Self-Pay

$730

Average discount available for prompt cash payment at this facility.

Insurance Median

$563

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: $730 (703%)

Insurance Median: $563 (542%)

Cash: $730 (703% of Medicare)

Ins. Median: $563 (542% 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 542% of the Medicare baseline (a markup of 442%). 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	$357 - $770	344%
Humana	$357	344%
Medica Mcr Adv	$357	344%
Medica Prime Sol	$357	344%
Tricare	$357	344%
Wellcare Mcr Adv - All Plans	$357	344%
Great Plains Mcr Adv - All Plans	$375	361%
Healthy Blue Mcaid - All Plans	$389	375%
Molina Mcaid - All Plans	$389	375%
Nebraska Total Care-All Plans	$389	375%
UnitedHealthcare	$389 - $779	375%
Amerigroup Mcaid - All Plans	$397	383%
Medica Chi Aco - All Other Plans	$730	703%
Medica Chi Open Access	$730	703%
Medica Ifb Aco	$730	703%
Medica Ifb Open Access	$730	703%
Midlands Choice-All Plans	$730	703%
Aetna	$795	766%
Multiplan-All Plans	$795	766%

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 $730.
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 Tri Valley Health System 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.