CMS Price Transparency Data

Group therapy session

Facility: Adena Pike Medical Center

Billing Code: 90853 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90853
Insurance Median: $287
Cash Discount Price: $191
vs. Medicare Baseline: 2.77x Medicare

The contracted insurance negotiated median rate for a Group therapy session at Adena Pike Medical Center is $287. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $191. Compared to the federal Medicare reimbursement reference rate of $103.79, this hospital’s rate is 2.77x the Medicare baseline. Located in 100 Dawn Lane, Waverly, OH.

Cash / Self-Pay

$191

Average discount available for prompt cash payment at this facility.

Insurance Median

$287

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: $191 (184%)

Insurance Median: $287 (277%)

Cash: $191 (184% of Medicare)

Ins. Median: $287 (277% 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 277% of the Medicare baseline (a markup of 177%). 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
Aetna	$91 - $310	88%
Blue Cross Blue Shield	$91 - $329	88%
Buckeye Community Health Plan	$91	88%
Humana	$91 - $362	88%
Medical Mutual Of Ohio	$91 - $242	88%
Medigold	$91	88%
Molina	$91	88%
Care Source	$93	90%
Gateway Health	$126	121%
Molina Marketplace	$150	145%
Care Source Just4Me	$165	159%
Sidecar Health	$252	243%
Ohio Ppo Connect	$267	257%
The Health Plan	$267	257%
Cigna	$276	266%
Medical Mutual Of Ohio Supermed	$287	277%
First Health	$299	288%
Ohio Health Choice	$303	292%
UnitedHealthcare	$328	316%
Integrated Health Plan	$358	345%
Healthsmart	$362	349%
Multiplan/Private Healthcare Systems	$362	349%
Three Rivers Network	$362	349%

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 $191.
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 Adena Pike 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.