CMS Price Transparency Data

Group therapy session

Facility: Mt Sinai Hospital Medical Center

Billing Code: 90853 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90853
Insurance Median: $109
Cash Discount Price: $86
vs. Medicare Baseline: 1.05x Medicare

The contracted insurance negotiated median rate for a Group therapy session at Mt Sinai Hospital Medical Center is $109. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $86. Compared to the federal Medicare reimbursement reference rate of $103.79, this hospital’s rate is 1.05x the Medicare baseline. Located in 15Th Street at California, Chicago, IL.

Cash / Self-Pay

$86

Average discount available for prompt cash payment at this facility.

Insurance Median

$109

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: $86 (83%)

Insurance Median: $109 (105%)

Cash: $86 (83% of Medicare)

Ins. Median: $109 (105% 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
Partners In Hlth - All Plans	$24 - $75	23%
Blue Cross Blue Shield	$26 - $321	25%
Compsych Ip/Op Only - All Plans	$35 - $250	34%
Healthlink Hmo	$38 - $121	37%
Hfn Platinum	$38 - $121	37%
Healthlink Ppo - All Other Plans	$41 - $131	40%
Multiplan Primary Ntwrk/Phcs - All Other Plans	$41 - $131	40%
Hfn Epo	$47 - $149	45%
Multiplan Complementary Ntwrk	$47 - $149	45%
Hfn Ppo - All Other Plans	$52 - $164	50%
Ambetter / Centene	$62 - $196	60%
Oscar - All Plans	$65 - $205	63%
Cigna	$73 - $337	70%
UnitedHealthcare	$99 - $109	95%
Tricare	$106	102%
Va Healthnet - All Plans	$106	102%
Advocate Physician Prtnrs Mcr	$109	105%
Cenpatico Illinicare Dual	$109	105%
Cenpatico Illinicare Mcr - All Other Plans	$109	105%
Evernorth Behav Hlth Mcr Adv	$109	105%
Humana	$109 - $586	105%
Lawndale Christian - All Plans	$109	105%
Meridian/Harmony D-Snp - All Plans	$109	105%
Nextlevel Hlth Icp Fhp Aca - All Plans	$109	105%
Harmony Behavioral Htlh - All Plans	$112	108%
Zing Mcr Adv - All Plans	$113	109%
Molina Mcr - All Other Plans	$114	110%
Advocate Physician Prtnrs - All Other Plans	$120	116%
Aetna	$134 - $422	129%
Cenpatico Illinicare Bh Mcaid	$321	309%
Family Health Network Mcaid - All Plans	$321	309%
Molina Mcaid	$337	325%

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 $86.
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 Mt Sinai Hospital 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.