CMS Price Transparency Data

Group therapy session

Facility: Palm Bay Hospital

Billing Code: 90853 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90853
Insurance Median: $232
Cash Discount Price: $73
vs. Medicare Baseline: 2.24x Medicare

The contracted insurance negotiated median rate for a Group therapy session at Palm Bay Hospital is $232. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $73. Compared to the federal Medicare reimbursement reference rate of $103.79, this hospital’s rate is 2.24x the Medicare baseline. Located in 1425 Malabar Rd, Ne, Palm Bay, FL.

Cash / Self-Pay

$73

Average discount available for prompt cash payment at this facility.

Insurance Median

$232

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: $73 (70%)

Insurance Median: $232 (224%)

Cash: $73 (70% of Medicare)

Ins. Median: $232 (224% 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 224% of the Medicare baseline (a markup of 124%). 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
Health First Health Plan	$28 - $99	27%
UnitedHealthcare	$86 - $290	83%
Florida Healthcare Plans	$92	89%
Corizon Health	$106	102%
Cigna	$112 - $119	108%
Disney Cruise Line	$174	168%
Prime Heath Services, Inc.	$218	210%
Multiplan	$232	224%
Aetna	$276 - $319	266%
Florida Blue	$283 - $303	273%
Amerigroup	$290	279%
Humana	$290	279%
Molina Healthcare	$290 - $325	279%
Sunshine Health Plan	$304	293%

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 $73.
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 Palm Bay 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.