CMS Price Transparency Data

Group therapy session

Facility: Cleveland Clinic Indian River Hospital

Billing Code: 90853 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90853
Insurance Median: $56
Cash Discount Price: $150
vs. Medicare Baseline: 0.54x Medicare

The contracted insurance negotiated median rate for a Group therapy session at Cleveland Clinic Indian River Hospital is $56. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $150. Compared to the federal Medicare reimbursement reference rate of $103.79, this hospital’s rate is 0.54x the Medicare baseline. Located in 1000 36Th St, Vero Beach, FL.

Cash / Self-Pay

$150

Average discount available for prompt cash payment at this facility.

Insurance Median

$56

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: $150 (145%)

Insurance Median: $56 (54%)

Cash: $150 (145% of Medicare)

Ins. Median: $56 (54% 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
UnitedHealthcare	$21	20%
Amerihealth	$22	21%
Medicaid / KanCare	$22	21%
Molina	$22	21%
Value Options	$22 - $26	21%
Wellcare	$22 - $93	21%
Avmed	$25 - $213	24%
Blue Cross Blue Shield	$25 - $93	24%
Careplus	$25 - $93	24%
Magellan	$25 - $445	24%
United	$25 - $93	24%
Cigna	$26 - $208	25%
Freedom Health	$26 - $93	25%
Independent Living Systems	$26 - $97	25%
Wellmed	$26 - $93	25%
Clear Spring Health	$27 - $38	26%
Aetna	$30 - $554	29%
Carelon Bh Strategies	$93	90%
Humana	$93	90%
Devoted Health	$102	98%
Bmi	$127 - $381	122%
Clarity Health	$146 - $450	141%
The Legacy Companies	$146 - $450	141%
National Provider Network	$157	151%
Three Rivers	$157	151%
Consociate Health	$168	162%
Multiplan	$185 - $554	178%

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 $150.
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 Cleveland Clinic Indian River 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.