CMS Price Transparency Data

Group therapy session

Facility: Lewisgale Medical Center

Billing Code: 90853 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90853
Insurance Median: $437
Cash Discount Price: $616
vs. Medicare Baseline: 4.21x Medicare

The contracted insurance negotiated median rate for a Group therapy session at Lewisgale Medical Center is $437. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $616. Compared to the federal Medicare reimbursement reference rate of $103.79, this hospital’s rate is 4.21x the Medicare baseline. Located in 1900 Electric Road, Salem, VA.

Cash / Self-Pay

$616

Average discount available for prompt cash payment at this facility.

Insurance Median

$437

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: $616 (594%)

Insurance Median: $437 (421%)

Cash: $616 (594% of Medicare)

Ins. Median: $437 (421% 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 421% of the Medicare baseline (a markup of 321%). 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
Cigna	$107 - $271	103%
Lifeworks	$117	113%
Universal Healthcare Group	$136	131%
Virginia Health Network	$216 - $437	208%
Aetna	$222 - $326	214%
United	$225 - $277	217%
Naphcare	$308	297%
Greenvbrier Sporting Club	$370	356%
Graham-White Manufacturing	$431	415%
Richfield Nursing Center	$431	415%
Corvel	$444	428%
Richfield Retirement Community	$462	445%
Csx Hotels	$493	475%
Occunet Workers Comp	$493	475%
One Health Plan	$493	475%
Patients Choice	$542	522%
4Most	$554	534%
Alleghany Highland Community	$554	534%
American Postal Workers Union	$554	534%
C&O Employees Hospital Assn	$554	534%
Multiplan	$554	534%
Phcs	$554	534%
Star Transportation	$554	534%

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 $616.
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 Lewisgale 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.