CMS Price Transparency Data

Group therapy session

Facility: St. Vincent's East

Billing Code: 90853 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90853
Insurance Median: $127
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.22x Medicare

The contracted insurance negotiated median rate for a Group therapy session at St. Vincent's East is $127. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $103.79, this hospital’s rate is 1.22x the Medicare baseline. Located in 50 Medical Park East Drive, Birmingham, AL.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$127

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%)

Insurance Median: $127 (122%)

Ins. Median: $127 (122% 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
Ambetter / Centene	$24 - $128	23%
Blue Cross Blue Shield	$89	86%
Cooper Green	$93	90%
UnitedHealthcare	$93 - $98	90%
Viva	$93 - $192	90%
Humana	$94 - $202	91%
Aetna	$96 - $160	92%
Cigna	$96 - $123	92%
Prime Health Services	$98 - $269	94%
Seven Corners	$125	120%
Construction Claims Management	$231	223%
Corvel	$231	223%
Alamed	$245	236%
Multiplan	$256	247%
Pnoa	$256	247%

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 $X.
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 St. Vincent's East 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.