CMS Price Transparency Data

Group therapy session

Facility: Lee County Community Hospital

Billing Code: 90853 (CPT)

The BaseRate · fair price medium confidence

A fair price for this

$114

about 1.1× the $104 Medicare rate · typically $39–$199

modeled estimate · not a bill or quote

What this hospital charges insurers

$212

Well above the fair price

about $98 over the fair price · 2.0× Medicare

Medicare pays $104 Fair price $114 This hospital $212 Cash price $49 Hospital's list price $212

How we calculate the fair BaseRate →

How this hospital compares to other VA hospitals

Highest price of the 9 VA hospitals we have prices for — worth calling around.

Cheapest $36 Priciest $212

Black dot = this hospital, among the 9 VA hospitals with a price for this procedure. Full list below.

A fair price for a Group therapy session is about $114 (about 1.1× the $104 Medicare rate). Lee County Community Hospital charges insurers about $212, or about $49 in cash — well above the fair price. Located in Pennington Gap, VA.

This price is above the fair BaseRate — you may be able to pay less

Ask the hospital for the cash / self-pay price, check whether you qualify for financial assistance, or negotiate the bill down toward the fair price of about $114. Many patients pay well below the first number they’re quoted — the checklists below walk you through it.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

5 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Cigna✓ Humana Kaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$47 - $472	45%
Blue Cross Blue Shieldmajor	$27 - $458	26%
Aetnamajor	$47 - $476	45%
Cignamajor	$49 - $212	47%
Humanamajor	$47	45%
Ambetter (Centene)	$47	45%
Amerigroup	$47 - $212	45%
Devoted Health	$49	47%
Molina	$49 - $476	47%
Sentara	$47 - $458	45%
+ 4 smaller / regional plans	$47 - $112

Government programs also on file: Medicare.

Excludes 2 rental-network / third-party entries (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price (about 49), before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the CPT code on your bill matches exactly: 90853.

Insurance Before you use insurance

Call your insurance company to confirm Lee County Community Hospital is in-network.
Ask your insurer whether prior approval is required for CPT code 90853.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at Lee County Community Hospital

Compare: Group therapy session at other VA hospitals

Insurance negotiated median for the same procedure, sorted lowest first.