CMS Price Transparency Data

Group therapy session

Facility: Grossmont Hospital

Billing Code: 90853 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90853
Insurance Median: $284
Cash Discount Price: $343
vs. Medicare Baseline: 2.74x Medicare

The contracted insurance negotiated median rate for a Group therapy session at Grossmont Hospital is $284. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $343. Compared to the federal Medicare reimbursement reference rate of $103.79, this hospital’s rate is 2.74x the Medicare baseline. Located in 5555 Grossmont Center Drive Box 58, La Mesa, CA.

Cash / Self-Pay

$343

Average discount available for prompt cash payment at this facility.

Insurance Median

$284

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: $343 (330%)

Insurance Median: $284 (274%)

Cash: $343 (330% of Medicare)

Ins. Median: $284 (274% 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 274% of the Medicare baseline (a markup of 174%). 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
Aetna	$4 - $12,997	4%
Health Net	$4 - $3,399	4%
Molina	$29 - $410	28%
California Health And Wellness	$64 - $364	62%
Blue Shield	$68 - $364	66%
Allianz Global Assistance	$69 - $446	66%
Managed Health Network	$69 - $3,999	66%
San Diego Pace	$80 - $341	77%
Medi-Cal	$120 - $3,999	116%
Blue Cross Blue Shield	$127 - $413	122%
Community Health Group	$127 - $341	122%
UnitedHealthcare	$129 - $373	124%
Cigna	$135 - $78,491	130%
Indian Health Council	$135 - $626	130%
Kaiser	$135 - $410	130%
County Medical Services	$136 - $3,399	131%
Humana	$140 - $353	135%
Interplan	$191 - $376	184%
Multiplan	$191 - $367	184%
Epic Americas	$193 - $344	186%
Medicare (plans)	$218 - $7,998	210%

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 $343.
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 Grossmont 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.