CMS Price Transparency Data

Group therapy session

Facility: Atrium Health Navicent the Medical Center

Billing Code: 90853 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90853
Insurance Median: $90
Cash Discount Price: $104
vs. Medicare Baseline: 0.87x Medicare

The contracted insurance negotiated median rate for a Group therapy session at Atrium Health Navicent the Medical Center is $90. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $104. Compared to the federal Medicare reimbursement reference rate of $103.79, this hospital’s rate is 0.87x the Medicare baseline. Located in 777 Hemlock Street, Macon, GA.

Cash / Self-Pay

$104

Average discount available for prompt cash payment at this facility.

Insurance Median

$90

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: $104 (100%)

Insurance Median: $90 (87%)

Cash: $104 (100% of Medicare)

Ins. Median: $90 (87% 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
Aetna	$24 - $143	23%
Blue Cross Blue Shield	$24 - $489	23%
Georgia Health Advantage	$24 - $90	23%
Humana	$24 - $142	23%
UnitedHealthcare	$24 - $90	23%
Care Source	$25 - $92	24%
Clover	$25 - $92	24%
Eon Health	$25 - $92	24%
Pruitt Health	$25 - $90	24%
Alliant	$29 - $358	28%
Ambetter / Centene	$32 - $106	31%
Cigna	$44 - $136	42%
Securehealth	$56 - $72	54%
Kaiser	$59 - $135	57%
Multiplan	$135 - $166	130%
Ibg	$146	141%
Novanet	$166	160%
Three Rivers Provider Network	$176	170%
Beechstreet	$193	186%

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 $104.
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 Atrium Health Navicent the Medical Center 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.