CMS Price Transparency Data

Group therapy session

Facility: HCA Florida North Florida Hospital

Billing Code: 90853 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90853
Insurance Median: $245
Cash Discount Price: $823
vs. Medicare Baseline: 2.36x Medicare

The contracted insurance negotiated median rate for a Group therapy session at HCA Florida North Florida Hospital is $245. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $823. Compared to the federal Medicare reimbursement reference rate of $103.79, this hospital’s rate is 2.36x the Medicare baseline. Located in 6500 W Newberry Rd, Gainesville, FL.

Cash / Self-Pay

$823

Average discount available for prompt cash payment at this facility.

Insurance Median

$245

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: $823 (793%)

Insurance Median: $245 (236%)

Cash: $823 (793% of Medicare)

Ins. Median: $245 (236% 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 236% of the Medicare baseline (a markup of 136%). 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
Corvel Corporation	$30 - $237	29%
Prime Health	$31 - $242	30%
Careworks (Rockport Community)	$32 - $250	31%
Avmed	$99 - $412	95%
Oscar	$99	95%
Simply Healthcare	$105	101%
Aetna	$120 - $247	116%
United	$123 - $370	119%
Simply	$127	122%
Cigna	$143 - $342	138%
Molina Healthcare	$156 - $263	150%
Humana	$165	159%
Plotkin Health	$412	397%
Prime Health Sheriff	$412	397%
Corizon Phs	$494	476%
Multiplan	$642 - $700	619%
Evolutions Healthcare	$700	674%
Ppo Next	$700	674%
Novanet	$741	714%

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 $823.
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 HCA Florida North Florida 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.