CMS Price Transparency Data

Group therapy session

Facility: Yoakum Community Hospital

Billing Code: 90853 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90853
Insurance Median: $173
Cash Discount Price: $150
vs. Medicare Baseline: 1.67x Medicare

The contracted insurance negotiated median rate for a Group therapy session at Yoakum Community Hospital is $173. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $150. Compared to the federal Medicare reimbursement reference rate of $103.79, this hospital’s rate is 1.67x the Medicare baseline. Located in 1200 Carl Ramert Drive, Yoakum, TX.

Cash / Self-Pay

$150

Average discount available for prompt cash payment at this facility.

Insurance Median

$173

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: $150 (145%)

Insurance Median: $173 (167%)

Cash: $150 (145% of Medicare)

Ins. Median: $173 (167% 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
Humana	$95	92%
Medicare (plans)	$95	92%
Prime Health Svcs Mcr Advantage	$95	92%
Scott & White Mcare Advan	$95	92%
Superior Mcr Advantage	$95	92%
Triwest Va Ccn-All Plans	$95	92%
Tx Independent Hp Mcr Advantage-All Plans	$95	92%
UnitedHealthcare	$95 - $168	92%
Blue Cross Blue Shield	$96 - $173	92%
Superior Hix-All Other Plans	$118	114%
Kempton Group Admin Ppo-All Plans	$152	146%
Entrust - All Plans	$161	155%
Medicaid / KanCare	$168 - $231	162%
Amera-Net-All Plans	$173	167%
Phcs Multiplan - All Plans	$173	167%
Scott & White Ppo-All Other Plans	$173	167%
Healthsmart Ppo-All Other Plans	$180	173%
Blue Bell Creameries Emp-All Plans	$185	178%
Cigna	$185	178%
Americas Health Plan-All Plans	$196	189%
Beech Street-All Plans	$196	189%
Directcare America-All Plans	$196	189%
Galaxy Ppo - All Plans	$196	189%
Health Star Comm Ip/Op Only - All Plans	$196	189%
Medcorp Southwest Ppo-All Plans	$196	189%
Medical Control Ppo-All Plans	$196	189%
Aetna	$208	200%
Healthsmart Work Comp	$208	200%
Prime Health Svcs Ppo-All Other Plans	$208	200%

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 $150.
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 Yoakum Community 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.