CMS Price Transparency Data
Group therapy session
Facility: Trinity Health Oakland Hospital
Billing Code: 90853 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 90853
- Insurance Median: $126
- Cash Discount Price: $120
- vs. Medicare Baseline: 1.21x Medicare
The contracted insurance negotiated median rate for a Group therapy session at Trinity Health Oakland Hospital is $126. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $120. Compared to the federal Medicare reimbursement reference rate of $103.79, this hospital’s rate is 1.21x the Medicare baseline. Located in 44405 Woodward Ave, Pontiac, MI.
Cash / Self-Pay
$120
Average discount available for prompt cash payment at this facility.
Insurance Median
$126
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: $120 (116%)
Insurance Median: $126 (121%)
Cash: $120 (116% of Medicare)
Ins. Median: $126 (121% 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
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Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Blue Cross Blue Shield | $43 - $66 | 41% |
| U Of M Health Plan | $50 | 48% |
| Wc Accident Fund | $56 | 54% |
| Wc Advantage | $56 | 54% |
| Wc Aig | $56 | 54% |
| Wc Allied | $56 | 54% |
| Wc Amerisure | $56 | 54% |
| Wc Amtrust | $56 | 54% |
| Wc Asu Risk Mgt | $56 | 54% |
| Wc Berkley Admin | $56 | 54% |
| Wc Broadspire | $56 | 54% |
| Wc Bunch & Associates | $56 | 54% |
| Wc Ccmsi | $56 | 54% |
| Wc Emc Insurance Company | $56 | 54% |
| Wc Esis | $56 | 54% |
| Wc Fcci | $56 | 54% |
| Wc Federated | $56 | 54% |
| Wc Gallagher Bassett | $56 | 54% |
| Wc Genex Care For Ohio | $56 | 54% |
| Wc Guard Insurance Company | $56 | 54% |
| Wc Hartford | $56 | 54% |
| Wc Liberty Mutual | $56 | 54% |
| Wc Meijers | $56 | 54% |
| Wc Michigan | $56 | 54% |
| Wc Mitchell Frankenmuth | $56 | 54% |
| Wc Pma | $56 | 54% |
| Wc Sedgwick | $56 | 54% |
| Wc Sentry | $56 | 54% |
| Wc Travelers | $56 | 54% |
| Wc Tristar | $56 | 54% |
| Wc Walmart | $56 | 54% |
| Wc Zurich | $56 | 54% |
| Aetna | $58 - $116 | 56% |
| Bcn Domestic | $66 | 64% |
| Blue Benefit Administrators Of Massachusetts | $66 | 64% |
| Blue Care Network | $66 | 64% |
| Blue Distinction Transplant | $66 | 64% |
| Blue Shield - Ca | $66 | 64% |
| Blue Shield - Id (Regence) | $66 | 64% |
| Blue Shield - Ny Highmark Northeastern | $66 | 64% |
| Blue Shield - Ny Highmark Western | $66 | 64% |
| Blue Shield - Pa (Highmark) | $66 | 64% |
| Blue Shield - Wa (Regence) | $66 | 64% |
| Health Choices | $66 - $136 | 64% |
| Kaiser Domestic | $66 | 64% |
| Acs Benefit Services | $81 | 78% |
| Allied Benefit Systems | $81 | 78% |
| Claimchoice Adminstrators | $81 | 78% |
| Consociate | $81 | 78% |
| Cypress Benefit Administrators | $81 | 78% |
| Forest County Potawatomi | $81 | 78% |
| Health Smart | $81 | 78% |
| Healthgram | $81 | 78% |
| Healthscope | $81 | 78% |
| Secureone Preferred United Plans | $81 | 78% |
| Sisco Benefits | $81 | 78% |
| The Health Plan | $81 | 78% |
| Trustmark Small Business Benefits | $81 | 78% |
| Unified Group Services | $81 | 78% |
| Webtpa | $81 | 78% |
| Mclaren Health | $89 - $97 | 86% |
| Carelon Behavioral Health | $92 | 89% |
| Asr Health Benefits | $94 | 91% |
| Caresource | $94 | 91% |
| Hap | $94 - $135 | 91% |
| Varipro | $94 | 91% |
| Magellan Behavioral Health | $111 | 107% |
| Geha | $116 - $139 | 112% |
| Medical Mutual | $116 | 112% |
| Meritain | $116 | 112% |
| 1199 National Benefit Fund | $126 | 121% |
| Allied National Global Care | $126 | 121% |
| Asrm - Reliance Standard Life Insurance | $126 | 121% |
| Christian Care Ministry | $126 | 121% |
| Dean Health | $126 | 121% |
| Fallon Health | $126 | 121% |
| Family Life Insurance Company | $126 | 121% |
| Ghc Scw | $126 | 121% |
| Group Pension Administrators | $126 | 121% |
| International Benefit Administrators | $126 | 121% |
| Lifetime Benefit Solutions | $126 | 121% |
| Manhattan Life | $126 | 121% |
| Medi Share | $126 | 121% |
| Multiplan | $126 | 121% |
| Mvp | $126 | 121% |
| Pai | $126 | 121% |
| Pan-American Life | $126 | 121% |
| Paramount Hmo | $126 | 121% |
| Phcs | $126 | 121% |
| Trinity Health Share | $126 | 121% |
| Priority Health | $134 - $149 | 129% |
| Health Partners | $135 | 130% |
| Tufts Health Plan | $135 | 130% |
| Access Health | $136 | 131% |
| Acclaim | $136 | 131% |
| Administrative Concepts | $136 | 131% |
| Allegeant | $136 | 131% |
| Ameriben | $136 | 131% |
| American Family | $136 | 131% |
| American Healthcare Alliance | $136 | 131% |
| American National | $136 | 131% |
| American Republic | $136 | 131% |
| Amerihealth | $136 | 131% |
| Aultcare | $136 | 131% |
| Automated Benefit Services | $136 | 131% |
| Auxiant | $136 | 131% |
| Benefit Administrative Systems,Llc | $136 | 131% |
| Boon Chapman | $136 | 131% |
| Cam Administrative Services | $136 | 131% |
| Christian Brother Services | $136 | 131% |
| Christian Brothers Holy Cross | $136 | 131% |
| Comprehensive Benefits | $136 | 131% |
| Continental Life Insurance | $136 | 131% |
| Custom Benefit Administrators | $136 | 131% |
| Employee Benefit Concepts | $136 | 131% |
| Employee Benefit Management | $136 | 131% |
| Enterprise Group Planning | $136 | 131% |
| Freedom Life Insurance Company | $136 | 131% |
| Group Administrators | $136 | 131% |
| Group Marketing Services | $136 | 131% |
| Guardian | $136 | 131% |
| Health America | $136 | 131% |
| Healthcare Management Admin | $136 | 131% |
| Healthez | $136 | 131% |
| Humana | $136 | 131% |
| Insight | $136 | 131% |
| Intercare | $136 | 131% |
| Jfp Benefit Management | $136 | 131% |
| Jp Farley Corporation | $136 | 131% |
| Key Benefit Administrator | $136 | 131% |
| Liberty Union Life Assurance Co | $136 | 131% |
| Lucent Health | $136 | 131% |
| Luminare Health | $136 | 131% |
| Luminare Health (Detroit) | $136 | 131% |
| Magnacare | $136 | 131% |
| Medben | $136 | 131% |
| Medcost | $136 | 131% |
| Mutual Health Services | $136 | 131% |
| Mutual Of Omaha | $136 | 131% |
| Ncas | $136 | 131% |
| Nippon Life Ins | $136 | 131% |
| Nova | $136 | 131% |
| Painters Union Insurance Fund | $136 | 131% |
| Physicians Mutual | $136 | 131% |
| Plumbers Local 98 Insurance Fund | $136 | 131% |
| Prairie States | $136 | 131% |
| Preferred One | $136 | 131% |
| Primary Physician Care | $136 | 131% |
| Professional Benefit Administrators | $136 | 131% |
| Siho Insurance Services | $136 | 131% |
| The Loomis Company | $136 | 131% |
| Unicare | $136 | 131% |
| Us Health And Life | $136 | 131% |
| Valenz | $136 | 131% |
| Western & Southern Financial Group | $136 | 131% |
| Wps | $136 | 131% |
| Cigna | $137 | 132% |
| Coventry | $139 | 134% |
| First Health | $139 | 134% |
| UnitedHealthcare | $139 | 134% |
| Prime Health Services | $148 | 143% |
| Three Rivers Provider Network | $166 | 160% |
| Cmh Detroit Wayne Integrated Health Network | $185 | 178% |
| Cmh Lenawee County | $185 | 178% |
| Cmh Misc | $185 | 178% |
| Cmh Monroe County | $185 | 178% |
| Cmh Oakland County | $185 | 178% |
| Cmh Washtenaw County | $185 | 178% |
| Cmh Livingston County | $195 | 188% |