CMS Price Transparency Data
Group therapy session
Facility: Palmetto General Hospital
Billing Code: 90853 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 90853
- Insurance Median: $95
- Cash Discount Price: $288
- vs. Medicare Baseline: 0.92x Medicare
The contracted insurance negotiated median rate for a Group therapy session at Palmetto General Hospital is $95. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $288. Compared to the federal Medicare reimbursement reference rate of $103.79, this hospital’s rate is 0.92x the Medicare baseline. Located in 2001 W 68Th St, Hialeah, FL.
Cash / Self-Pay
$288
Average discount available for prompt cash payment at this facility.
Insurance Median
$95
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: $288 (277%)
Insurance Median: $95 (92%)
Cash: $288 (277% of Medicare)
Ins. Median: $95 (92% 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
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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 | $9 - $288 | 9% |
| Oscar Health Plan Hix | $18 | 17% |
| Imagine Health | $29 | 28% |
| Healthsun Health Plans | $30 - $94 | 29% |
| Self Pay/Uninsured | $36 - $112 | 35% |
| Employer Direct Healthcare | $37 - $91 | 36% |
| Bc/Bs Of Fl Network Blue | $44 | 42% |
| Bc/Bs Of Fl Blue Select Exchange Non Par | $47 | 45% |
| Cigna | $50 - $144 | 48% |
| Bc/Bs Of Fl Health Options Hmo | $55 | 53% |
| Bc/Bs Myblue Hmo Hix | $58 | 56% |
| Bc/Bs Of Fl Miami Dade Blue Select | $58 | 56% |
| Bc/Bs Of Fl Simplyblue | $61 | 59% |
| Veterans Administration Mill Bill | $63 | 61% |
| Bc/Bs Of Fl Ppo | $72 | 69% |
| Medicaid / KanCare | $72 - $288 | 69% |
| Avmed Broad Network | $78 | 75% |
| Medicare (plans) | $81 - $288 | 78% |
| Humana | $86 - $117 | 83% |
| Leon Health Inc | $89 | 86% |
| Devoted Health | $90 | 87% |
| Tricare | $90 | 87% |
| UnitedHealthcare | $90 | 87% |
| Bristol Hospice- Miami Dade Llc | $91 | 88% |
| Catholic Hospice | $91 | 88% |
| Compassionate Care Hospice Of Miami Dade And The Fl Keys Inc | $91 | 88% |
| Hospice Other | $91 | 88% |
| Ima Evalutations Inc | $91 | 88% |
| Odyssey Healthcare Of Marion County Dba Kindred Hospice | $91 | 88% |
| Opuscare Of South Fl | $91 | 88% |
| Seasons Hospice And Pallative Care Of Southern Florida Inc | $91 | 88% |
| Select Specialty Hospital | $91 | 88% |
| Veterans Administration Vaccn | $91 | 88% |
| Vitas Healthcare Hospice | $91 | 88% |
| Westchester General Hospital | $91 | 88% |
| Longevity Health Plan | $96 | 92% |
| Florida Pace Centers | $107 | 103% |
| Bright Health Management Commercial | $109 | 105% |
| Naphcare Inc | $125 - $187 | 120% |
| Liga Contra El Cancer | $144 | 139% |
| Bc/Bs Of Fl Phs | $145 | 140% |
| Beacon Health Strategies Commercial | $150 - $288 | 145% |
| New Directions Behavioral Health Commercial | $151 | 145% |
| New Directions Behavioral Health Exchange | $151 | 145% |
| Avmed Exchange | $159 | 153% |
| Ambetter / Centene | $168 | 162% |
| Magellan Behavioral Health | $173 | 167% |
| Molina Marketplace Program Exchange | $173 | 167% |
| Auto Insurance | $182 | 175% |
| Avmed Select Network | $186 | 179% |
| Dimensions International | $187 | 180% |
| First Health | $193 | 186% |
| Amerihealth Caritas Next Exchange | $196 | 189% |
| Dimension Health Ppo | $216 | 208% |
| Dimension Health Wc | $216 | 208% |
| Workers Compensation | $216 | 208% |
| Commercial Non-Contracted | $288 | 277% |
| Self Pay - Mcd Pending 100 Percent | $288 | 277% |
| Single Case Agreement | $288 | 277% |
| United Behavioral Health Psych | $288 - $431 | 277% |
| Concordia Behavioral Health Dba Carisk Partners | $389 | 375% |