CMS Price Transparency Data

Group therapy session

Facility: Uva Health Culpeper Medical Center

Billing Code: 90853 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90853
Insurance Median: $215
Cash Discount Price: $253
vs. Medicare Baseline: 2.07x Medicare

The contracted insurance negotiated median rate for a Group therapy session at Uva Health Culpeper Medical Center is $215. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $253. Compared to the federal Medicare reimbursement reference rate of $103.79, this hospital’s rate is 2.07x the Medicare baseline. Located in 501 Sunset Lane, Culpeper, VA.

Cash / Self-Pay

$253

Average discount available for prompt cash payment at this facility.

Insurance Median

$215

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: $253 (244%)

Insurance Median: $215 (207%)

Cash: $253 (244% of Medicare)

Ins. Median: $215 (207% 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 207% of the Medicare baseline (a markup of 107%). 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
Champva [50002]	$23	22%
Tricare	$23	22%
Cigna	$39 - $250	38%
Beacon Health Options [40012]	$50 - $227	48%
Commercial Contracted Hb Only [40056]	$53 - $238	51%
Commercial Generic [40000]	$53 - $318	51%
Commercial Contracted Tpa [40055]	$61 - $318	59%
UnitedHealthcare	$61 - $272	59%
Umwa [40037]	$71 - $318	68%
Aetna	$75 - $400	72%
Healthsmart [40013]	$76 - $340	73%
First Health Generic [40033]	$83 - $372	80%
Gateway Health Alliance [40034]	$86 - $386	83%
Multiplan Generic [40035]	$86 - $531	83%
Vhn Generic [40040]	$86 - $531	83%
Sentara [40021]	$115 - $242	111%
Sentara Behavioral Health [40052]	$118 - $242	114%
Geha [40009]	$125	120%
Carefirst [30007]	$165 - $370	159%
Blue Cross Blue Shield	$169	163%
Kaiser Permenente [40014]	$281 - $400	271%

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 $253.
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 Uva Health Culpeper 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.