CMS Price Transparency Data

Group therapy session

Facility: Winter Haven Hospital

Billing Code: 90853 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90853
Insurance Median: $53
Cash Discount Price: $35
vs. Medicare Baseline: 0.51x Medicare

The contracted insurance negotiated median rate for a Group therapy session at Winter Haven Hospital is $53. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $35. Compared to the federal Medicare reimbursement reference rate of $103.79, this hospital’s rate is 0.51x the Medicare baseline. Located in 200 Ave F Ne, Winter Haven, FL.

Cash / Self-Pay

$35

Average discount available for prompt cash payment at this facility.

Insurance Median

$53

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: $35 (34%)

Insurance Median: $53 (51%)

Cash: $35 (34% of Medicare)

Ins. Median: $53 (51% 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
Molina	$11 - $35	11%
Simply Healthcare	$11 - $91	11%
Avmed	$18 - $29	17%
Ultimate Health Plan	$18	17%
Blue Cross Blue Shield	$19 - $93	18%
Aetna	$27 - $107	26%
Florida Hospital	$27	26%
Evolutions	$30 - $55	29%
Cigna	$31 - $107	30%
UnitedHealthcare	$31 - $99	30%
Multiplan	$47	45%
First Health	$50	48%
Ambetter / Centene	$59 - $237	57%
United Behavioral Health	$59	57%
Clear Health Alliance	$88	85%
Humana	$90 - $116	87%
Freedom Health	$91	88%
Molina Healthcare	$91	88%
Sunshine Health	$91	88%
Careplus	$92	89%
Baycareplus	$93	90%
Florida Community Care	$96	92%
Freedom	$98	94%
Optimum	$98	94%
Solis Health	$102	98%
Health First	$107	103%
Wellcare	$130	125%

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 $35.
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 Winter Haven 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.