CMS Price Transparency Data

Group therapy session

Facility: Novant Health Presbyterian Medical Center

Billing Code: 90853 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90853
Insurance Median: $230
Cash Discount Price: $185
vs. Medicare Baseline: 2.22x Medicare

The contracted insurance negotiated median rate for a Group therapy session at Novant Health Presbyterian Medical Center is $230. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $185. Compared to the federal Medicare reimbursement reference rate of $103.79, this hospital’s rate is 2.22x the Medicare baseline. Located in 200 Hawthorne Lane Box 33549, Charlotte, NC.

Cash / Self-Pay

$185

Average discount available for prompt cash payment at this facility.

Insurance Median

$230

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: $185 (178%)

Insurance Median: $230 (222%)

Cash: $185 (178% of Medicare)

Ins. Median: $230 (222% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 222% of the Medicare baseline (a markup of 122%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Carolina Complete	$64 - $65	62%
Nc Department Of Public Safety	$64 - $197	62%
Amerihealth	$65 - $66	63%
Blue Cross Blue Shield	$65 - $267	63%
UnitedHealthcare	$65 - $217	63%
Wellcare	$65 - $66	63%
Humana	$99 - $267	95%
Pace Of The Southern Piedmont	$99	95%
Aetna	$101 - $297	97%
Cigna	$102 - $191	98%
Liberty Health	$104	100%
Caresource North Carolina	$121 - $122	117%
Atlantic Corporation Dba Atlantic Packaging	$169 - $171	163%
Amps	$202 - $204	195%
Plotkin Health	$220 - $223	212%
Medcost	$261 - $278	251%
Primary Physician Care	$272 - $275	262%
Multiplan	$275 - $278	265%
Phcs	$275 - $278	265%
Employers Choice Network	$356 - $360	343%
Three Rivers Provider Network	$356 - $360	343%

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 $185.
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 Novant Health Presbyterian 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.