CMS Price Transparency Data

Group therapy session

Facility: Good Samaritan Hospital

Billing Code: 90853 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90853
Insurance Median: $430
Cash Discount Price: $1,448
vs. Medicare Baseline: 4.14x Medicare

The contracted insurance negotiated median rate for a Group therapy session at Good Samaritan Hospital is $430. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,448. Compared to the federal Medicare reimbursement reference rate of $103.79, this hospital’s rate is 4.14x the Medicare baseline. Located in 2425 Samaritan Drive, San Jose, CA.

Cash / Self-Pay

$1,448

Average discount available for prompt cash payment at this facility.

Insurance Median

$430

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: $1,448 (1395%)

Insurance Median: $430 (414%)

Cash: $1,448 (1395% of Medicare)

Ins. Median: $430 (414% 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 414% of the Medicare baseline (a markup of 314%). 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
Blue Cross Blue Shield	$4	4%
Physicians Medical Group	$4	4%
Blue Shield	$80 - $430	77%
Medcare Partners	$217	209%
Santa Clara Family Health Plan	$275	265%
Bright Health	$291	280%
Aetna	$301 - $307	290%
Cigna	$337 - $358	325%
Health Net	$338	326%
United	$369	356%
Healthsmart	$400 - $1,231	385%
Santa Clara Ipa Comm	$724	698%
Santa Clara Ipa Mcr	$724	698%
Nx Health Network	$869	837%
Sutter Select	$869	837%
Multiplan	$942 - $1,159	908%
Humana	$1,014	977%
First Health	$1,101 - $1,448	1061%
Intercontinental Corporation	$1,159	1117%
Pha Pacific Health Alliance	$1,159	1117%
Ppo Next	$1,159	1117%

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 $1,448.
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 Good Samaritan 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.