CMS Price Transparency Data
Group therapy session
Facility: Trinity Health Muskegon Hospital
Billing Code: 90853 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 90853
- Insurance Median: $63
- Cash Discount Price: $55
- vs. Medicare Baseline: 0.61x Medicare
The contracted insurance negotiated median rate for a Group therapy session at Trinity Health Muskegon Hospital is $63. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $55. Compared to the federal Medicare reimbursement reference rate of $103.79, this hospital’s rate is 0.61x the Medicare baseline. Located in 1500 E Sherman Blvd, Muskegon, MI.
Cash / Self-Pay
$55
Average discount available for prompt cash payment at this facility.
Insurance Median
$63
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: $55 (53%)
Insurance Median: $63 (61%)
Cash: $55 (53% of Medicare)
Ins. Median: $63 (61% 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 |
|---|---|---|
| Aetna | $35 - $57 | 34% |
| Bcn Domestic | $41 | 40% |
| Blue Benefit Administrators Of Massachusetts | $41 | 40% |
| Blue Care Network | $41 | 40% |
| Blue Cross Blue Shield | $41 | 40% |
| Blue Distinction Transplant | $41 | 40% |
| Blue Shield - Ca | $41 | 40% |
| Blue Shield - Id (Regence) | $41 | 40% |
| Blue Shield - Ny Highmark Northeastern | $41 | 40% |
| Blue Shield - Ny Highmark Western | $41 | 40% |
| Blue Shield - Pa (Highmark) | $41 | 40% |
| Blue Shield - Wa (Regence) | $41 | 40% |
| Health Choices | $41 - $66 | 40% |
| Kaiser Domestic | $41 | 40% |
| Acs Benefit Services | $44 | 42% |
| Allied Benefit Systems | $44 | 42% |
| Claimchoice Adminstrators | $44 | 42% |
| Consociate | $44 | 42% |
| Cypress Benefit Administrators | $44 | 42% |
| Forest County Potawatomi | $44 | 42% |
| Health Smart | $44 | 42% |
| Healthgram | $44 | 42% |
| Healthscope | $44 | 42% |
| Preferred One | $44 | 42% |
| Secureone Preferred United Plans | $44 | 42% |
| Sisco Benefits | $44 | 42% |
| The Health Plan | $44 | 42% |
| Trustmark Small Business Benefits | $44 | 42% |
| Unified Group Services | $44 | 42% |
| Webtpa | $44 | 42% |
| Asr Health Benefits | $45 | 43% |
| Hap | $45 - $67 | 43% |
| Wc Accident Fund | $45 | 43% |
| Wc Advantage | $45 | 43% |
| Wc Aig | $45 | 43% |
| Wc Allied | $45 | 43% |
| Wc Amerisure | $45 | 43% |
| Wc Amtrust | $45 | 43% |
| Wc Asu Risk Mgt | $45 | 43% |
| Wc Berkley Admin | $45 | 43% |
| Wc Broadspire | $45 | 43% |
| Wc Bunch & Associates | $45 | 43% |
| Wc Ccmsi | $45 | 43% |
| Wc Emc Insurance Company | $45 | 43% |
| Wc Esis | $45 | 43% |
| Wc Fcci | $45 | 43% |
| Wc Federated | $45 | 43% |
| Wc Gallagher Bassett | $45 | 43% |
| Wc Genex Care For Ohio | $45 | 43% |
| Wc Guard Insurance Company | $45 | 43% |
| Wc Hartford | $45 | 43% |
| Wc Liberty Mutual | $45 | 43% |
| Wc Meijers | $45 | 43% |
| Wc Michigan | $45 | 43% |
| Wc Mitchell Frankenmuth | $45 | 43% |
| Wc Pma | $45 | 43% |
| Wc Sedgwick | $45 | 43% |
| Wc Sentry | $45 | 43% |
| Wc Travelers | $45 | 43% |
| Wc Tristar | $45 | 43% |
| Wc Walmart | $45 | 43% |
| Wc Zurich | $45 | 43% |
| Hospice Of Michigan | $46 | 44% |
| Nomi Health | $47 | 45% |
| Varipro | $49 | 47% |
| U Of M Health Plan | $50 - $66 | 48% |
| Caresource | $53 | 51% |
| Cigna | $53 | 51% |
| Geha | $57 - $74 | 55% |
| Meritain | $57 | 55% |
| 1199 National Benefit Fund | $63 | 61% |
| Allied National Global Care | $63 | 61% |
| Asrm - Reliance Standard Life Insurance | $63 | 61% |
| Christian Care Ministry | $63 | 61% |
| Dean Health | $63 | 61% |
| Fallon Health | $63 | 61% |
| Family Life Insurance Company | $63 | 61% |
| Ghc Scw | $63 | 61% |
| Group Pension Administrators | $63 | 61% |
| International Benefit Administrators | $63 | 61% |
| Lifetime Benefit Solutions | $63 | 61% |
| Manhattan Life | $63 | 61% |
| Medi Share | $63 | 61% |
| Multiplan | $63 | 61% |
| Mvp | $63 | 61% |
| Pai | $63 | 61% |
| Pan-American Life | $63 | 61% |
| Paramount Hmo | $63 | 61% |
| Phcs | $63 | 61% |
| Trinity Health Share | $63 | 61% |
| Acclaim | $66 | 64% |
| Administrative Concepts | $66 | 64% |
| Allegeant | $66 | 64% |
| Ameriben | $66 | 64% |
| American Family | $66 | 64% |
| American Healthcare Alliance | $66 | 64% |
| American Republic | $66 | 64% |
| Amerihealth | $66 | 64% |
| Aultcare | $66 | 64% |
| Automated Benefit Services | $66 | 64% |
| Auxiant | $66 | 64% |
| Benefit Administrative Systems,Llc | $66 | 64% |
| Boon Chapman | $66 | 64% |
| Cam Administrative Services | $66 | 64% |
| Christian Brother Services | $66 | 64% |
| Christian Brothers Holy Cross | $66 | 64% |
| Comprehensive Benefits | $66 | 64% |
| Continental Life Insurance | $66 | 64% |
| Custom Benefit Administrators | $66 | 64% |
| Employee Benefit Concepts | $66 | 64% |
| Employee Benefit Management | $66 | 64% |
| Enterprise Group Planning | $66 | 64% |
| Freedom Life Insurance Company | $66 | 64% |
| Group Administrators | $66 | 64% |
| Group Marketing Services | $66 | 64% |
| Guardian | $66 | 64% |
| Health America | $66 | 64% |
| Healthez | $66 | 64% |
| Humana | $66 | 64% |
| Insight | $66 | 64% |
| Intercare | $66 | 64% |
| Jfp Benefit Management | $66 | 64% |
| Jp Farley Corporation | $66 | 64% |
| Key Benefit Administrator | $66 | 64% |
| Liberty Union Life Assurance Co | $66 | 64% |
| Lucent Health | $66 | 64% |
| Luminare Health | $66 | 64% |
| Luminare Health (Detroit) | $66 | 64% |
| Medben | $66 | 64% |
| Medcost | $66 | 64% |
| Medical Mutual | $66 | 64% |
| Mutual Health Services | $66 | 64% |
| Mutual Of Omaha | $66 | 64% |
| Ncas | $66 | 64% |
| Nippon Life Ins | $66 | 64% |
| Nova | $66 | 64% |
| Painters Union Insurance Fund | $66 | 64% |
| Physicians Mutual | $66 | 64% |
| Plumbers Local 98 Insurance Fund | $66 | 64% |
| Prairie States | $66 | 64% |
| Primary Physician Care | $66 | 64% |
| Professional Benefit Administrators | $66 | 64% |
| The Loomis Company | $66 | 64% |
| Unicare | $66 | 64% |
| Us Health And Life | $66 | 64% |
| Valenz | $66 | 64% |
| Western & Southern Financial Group | $66 | 64% |
| Wps | $66 | 64% |
| First Health | $69 | 66% |
| UnitedHealthcare | $74 | 71% |
| Barinet | $84 | 81% |
| Cmh Allegan County | $84 | 81% |
| Cmh Barry County | $84 | 81% |
| Cmh Berrien County | $84 | 81% |
| Cmh Cass County | $84 | 81% |
| Cmh Kalamazoo | $84 | 81% |
| Cmh Kent County | $84 | 81% |
| Cmh Misc | $84 | 81% |
| Cmh Muskegon County | $84 | 81% |
| Cmh North Country | $84 | 81% |
| Cmh Northern Lakes County | $84 | 81% |
| Cmh Ottawa County | $84 | 81% |
| Cmh Van Buren County | $84 | 81% |
| Cmh West Mi County | $84 | 81% |
| Priority Health | $99 - $111 | 95% |