CMS Price Transparency Data

Group therapy session

Facility: Northside Hospital Duluth

Billing Code: 90853 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 90853
  • Insurance Median: $137
  • Cash Discount Price: $206
  • vs. Medicare Baseline: 1.32x Medicare
The contracted insurance negotiated median rate for a Group therapy session at Northside Hospital Duluth is $137. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $206. Compared to the federal Medicare reimbursement reference rate of $103.79, this hospital’s rate is 1.32x the Medicare baseline. Located in 3620 Howell Ferry Road, Duluth, GA.
Cash / Self-Pay
$206

Average discount available for prompt cash payment at this facility.

Insurance Median
$137

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: $206 (198%)
Insurance Median: $137 (132%)
Cash: $206 (198% of Medicare)
Ins. Median: $137 (132% 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.

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
Ambetter / Centene $17 - $193 16%
Institutional Gwinnett County Govt $17 - $74 16%
Medicaid / KanCare $17 - $85 16%
Caresource $18 - $153 17%
Champus Va $18 17%
Amerigroup $21 - $71 20%
Cigna $21 - $259 20%
Us Dept Of Labor Wc $34 33%
Blue Cross Blue Shield $38 - $286 37%
Mti $47 45%
One Call Diagnostics $47 45%
Homelink $50 48%
Georgia Reproductive Specialists $55 - $164 53%
Medlien Healthcare Services $55 - $164 53%
Med Care Solutions $62 - $185 60%
Oscar $64 - $193 62%
Aetna $68 - $279 66%
Health One Alliance_Ppo $75 - $226 72%
Quick Trip $75 - $226 72%
Coventry $82 - $279 79%
Northside Health Network $85 - $255 82%
Kaiser $89 - $358 86%
Novanet_Ppo $96 - $288 92%
Clear Springs Eon Health $100 96%
Medicare (plans) $100 - $120 96%
UnitedHealthcare $100 96%
Va Ccn $100 96%
Humana $101 - $104 97%
Bccp $102 98%
Cbww $102 98%
Truths Community $102 98%
Phcs $103 - $308 99%
Tricare $103 99%
Wellcare $103 99%
Clover Health $105 101%
Pruitt Health Premier $105 101%
Fairly Group $115 111%
Beech Steet $116 - $349 112%
Multiplan $116 - $349 112%
Multiplan Workers Comp $116 - $349 112%
Careiq $137 - $411 132%
Dekalb_Department Of Health $137 - $411 132%
Fifa $137 - $411 132%
Institutional Marietta Surgery Center $137 - $411 132%
Institutional Veterans Evaluation Services $137 - $411 132%
Johnson Ferry Imaging $137 - $411 132%
Marietta Dermatology Clinical Research Inc $137 - $411 132%
Rabun County Boc $137 - $411 132%
West Paces Imaging Agreement $137 - $411 132%
Genex/Priority Care Solutions $194 187%
Spreemo $194 187%
Authentic 4D $218 210%
Streamline Imaging $218 210%
Corvel Workers Comp $230 222%
Employers Choice Network $230 222%
Fieldale Farms Wc $242 233%
Georgia Workers Compensation $242 233%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 3620 Howell Ferry Road, Duluth, GA 30096
  • CMS Rating: ★★★★☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals