CMS Price Transparency Data

Group therapy session

Facility: Carolina East Medical Center

Billing Code: 90853 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90853
Insurance Median: $72
Cash Discount Price: $65
vs. Medicare Baseline: 0.69x Medicare

The contracted insurance negotiated median rate for a Group therapy session at Carolina East Medical Center is $72. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $65. Compared to the federal Medicare reimbursement reference rate of $103.79, this hospital’s rate is 0.69x the Medicare baseline. Located in 2000 Neuse Blvd, New Bern, NC.

Cash / Self-Pay

$65

Average discount available for prompt cash payment at this facility.

Insurance Median

$72

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: $65 (63%)

Insurance Median: $72 (69%)

Cash: $65 (63% of Medicare)

Ins. Median: $72 (69% 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
Pamlico Co Jail-All Plans	$21 - $36	20%
Humana	$24 - $97	23%
Inclusive Health (Nchirp)-All Plans	$24 - $97	23%
Tricare	$24 - $135	23%
UnitedHealthcare	$28 - $96	27%
Craven Co. Jail Systems - All Plans	$46 - $51	44%
Medcost Ppo Employees And Retirees	$53 - $89	51%
Medcost Ppo Ultra (Employees)	$53 - $84	51%
Blue Cross Blue Shield	$56 - $93	54%
Medcost Ppo City Employees	$58 - $98	56%
Medcost Ppo County Employee	$61 - $102	59%
Benefit Mgmt, Svcs-All Plans	$68 - $115	66%
Aetna	$71 - $120	68%
Medcost Benefit Svc-All Other Plans	$71 - $119	68%
Acs Consult Svc Inc-All Plans	$72 - $122	69%
Medcost Ppo Standard	$72 - $122	69%
Cigna	$73 - $123	70%

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 $65.
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 Carolina East 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.