CMS Price Transparency Data

Group therapy session

Facility: Pine Rest Christian Mental Health Services

Billing Code: 90853 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90853
Insurance Median: $27
Cash Discount Price: $62
vs. Medicare Baseline: 0.26x Medicare

The contracted insurance negotiated median rate for a Group therapy session at Pine Rest Christian Mental Health Services is $27. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $62. Compared to the federal Medicare reimbursement reference rate of $103.79, this hospital’s rate is 0.26x the Medicare baseline. Located in 300 - 68Th Street, Se, Grand Rapids, MI.

Cash / Self-Pay

$62

Average discount available for prompt cash payment at this facility.

Insurance Median

$27

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: $62 (60%)

Insurance Median: $27 (26%)

Cash: $62 (60% of Medicare)

Ins. Median: $27 (26% 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
Medicaid / KanCare	$12 - $43	12%
UnitedHealthcare	$12 - $63	12%
Aetna	$15 - $71	14%
Blue Cross Blue Shield	$15 - $36	14%
Champva [1117]	$18 - $27	17%
Humana	$18 - $32	17%
Medicare (plans)	$18 - $27	17%
Molina [1156]	$18 - $27	17%
Tricare	$18 - $27	17%
Veterans Administration [1174]	$18 - $27	17%
University Of Michigan Health Plan Comm [1159]	$26 - $34	25%
University Of Michigan Health Plan [1205]	$26 - $34	25%
Beacon/Carelon Behavioral Health [1198]	$31 - $33	30%
Asr Physicians Care Health Plan [1160]	$32 - $38	31%
Hap Ppo/Health Alliance Plan [1134]	$32 - $38	31%
Mclaren Health Plan [1149]	$36	35%
Network 180 [3530]	$37	36%
Blue Care Network [1000]	$40 - $45	39%
Cigna	$45 - $64	43%
Manistee Benzie County Cmh [3526]	$50	48%
Priority Health [1300]	$52 - $63	50%
Behavioral Health Systems [1115]	$57 - $69	55%
Golden Rule [1131]	$63	61%
Healthscope Benefits [1140]	$63	61%
Ubh [1167]	$63	61%
Compsych [1122]	$68 - $76	66%
Cofinity [1120]	$69 - $71	66%
Geha [1129]	$69 - $71	66%
Meritain Health Plan [1153]	$69 - $71	66%

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 $62.
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 Pine Rest Christian Mental Health Services 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.