CMS Price Transparency Data

Group therapy session

Facility: Fairfield Medical Center

Billing Code: 90853 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90853
Insurance Median: $6,085
Cash Discount Price: Unavailable
vs. Medicare Baseline: 58.63x Medicare

The contracted insurance negotiated median rate for a Group therapy session at Fairfield Medical Center is $6,085. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $103.79, this hospital’s rate is 58.63x the Medicare baseline. Located in 401 North Ewing Street, Lancaster, OH.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$6,085

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%)

Insurance Median: $6,085 (5863%)

Ins. Median: $6,085 (5863% 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 5863% of the Medicare baseline (a markup of 5763%). 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
Medicaid / KanCare	$122	118%
Molina	$122 - $10,044	118%
UnitedHealthcare	$122 - $6,087	118%
Caresource	$123 - $7,913	119%
Blue Cross Blue Shield	$126 - $26,250	121%
Humana	$127 - $5,966	122%
Amerihealth Caritas Ohio	$128	123%
Buckeye Community Health	$128 - $9,435	123%
Aetna	$5,966	5748%
Medical Mutual	$5,966 - $33,500	5748%
Medicare (plans)	$5,966	5748%
The Health Plan	$6,085	5863%
Valor Health Plan	$6,085	5863%
Medigold	$6,087	5865%
Va Ccn	$6,087	5865%
Oscar	$6,170	5945%
Bwc	$8,455	8146%

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 $X.
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 Fairfield 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.