CMS Price Transparency Data

Group therapy session

Facility: Atrium Health Pineville

Billing Code: 90853 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90853
Insurance Median: $88
Cash Discount Price: $101
vs. Medicare Baseline: 0.85x Medicare

The contracted insurance negotiated median rate for a Group therapy session at Atrium Health Pineville is $88. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $101. Compared to the federal Medicare reimbursement reference rate of $103.79, this hospital’s rate is 0.85x the Medicare baseline. Located in 10628 Park Rd, Charlotte, NC.

Cash / Self-Pay

$101

Average discount available for prompt cash payment at this facility.

Insurance Median

$88

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: $101 (97%)

Insurance Median: $88 (85%)

Cash: $101 (97% of Medicare)

Ins. Median: $88 (85% 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
Amerihealth Caritas	$20 - $24	19%
Partners	$20 - $24	19%
Alliance	$21 - $24	20%
Carolina Complete Health	$21 - $24	20%
Healthy Blue	$21 - $24	20%
Trillium	$21 - $24	20%
Vaya	$21 - $24	20%
Wellcare	$21 - $24	20%
Cigna	$24 - $136	23%
Humana	$24 - $90	23%
UnitedHealthcare	$24 - $95	23%
Aetna	$25 - $167	24%
Ortho Carolina	$30 - $110	29%
Ambetter / Centene	$59 - $73	57%
Blue Cross Blue Shield	$59 - $78	57%
Choicecare	$61 - $149	59%
Employers Health Network	$89	86%
Physician Reach Out	$101	97%
Medcost	$108 - $121	104%
Magellan	$121 - $367	117%
Gmmi	$131	126%
Quik Trip	$131	126%
Healthgram	$161	155%
Provider Select	$163 - $181	157%
Private Health Care Systems	$165	159%
First Health	$167	161%
Beechstreet	$181	174%
Multiplan	$185	178%

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 $101.
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 Atrium Health Pineville 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.