CMS Price Transparency Data

Group therapy session

Facility: North Carolina Baptist Hospital

Billing Code: 90853 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 90853
  • Insurance Median: $48
  • Cash Discount Price: $69
  • vs. Medicare Baseline: 0.46x Medicare
The contracted insurance negotiated median rate for a Group therapy session at North Carolina Baptist Hospital is $48. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $69. Compared to the federal Medicare reimbursement reference rate of $103.79, this hospital’s rate is 0.46x the Medicare baseline. Located in Medical Center Boulevard, Winston-Salem, NC.
Cash / Self-Pay
$69

Average discount available for prompt cash payment at this facility.

Insurance Median
$48

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: $69 (66%)
Insurance Median: $48 (46%)
Cash: $69 (66% of Medicare)
Ins. Median: $48 (46% 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
Medcost $27 - $94 26%
Blue Cross Blue Shield $28 - $90 27%
Amerihealth $30 - $38 29%
Carolina Complete $30 - $32 29%
Health Blue $30 - $32 29%
Partners $30 - $32 29%
Alliance $31 - $33 30%
Trillium $31 - $33 30%
UnitedHealthcare $31 - $90 30%
Vaya $31 - $32 30%
Wellcare $31 - $90 30%
Aetna $32 - $121 31%
Ambetter / Centene $36 - $38 35%
Oscar $40 - $51 39%
Cigna $41 - $90 40%
Humana $73 - $90 70%
Directnet $79 - $84 76%
Apex $90 87%
Devoted $90 87%
Healthteam $90 87%
Medicare (plans) $90 87%
Cone Health $94 - $99 91%
Healthgram $94 - $99 91%
Liberty $103 99%
First Carolina Care $107 - $114 103%
Private Healthcare Systems $110 - $116 106%
Multiplan $121 - $128 117%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: Medical Center Boulevard, Winston-Salem, NC 27157
  • CMS Rating: ★★★★☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals