CMS Price Transparency Data

Group therapy session

Facility: Triangle Springs

Billing Code: 90853 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90853
Insurance Median: $275
Cash Discount Price: $280
vs. Medicare Baseline: 2.65x Medicare

The contracted insurance negotiated median rate for a Group therapy session at Triangle Springs is $275. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $280. Compared to the federal Medicare reimbursement reference rate of $103.79, this hospital’s rate is 2.65x the Medicare baseline. Located in 10901 World Trade Blvd, Raleigh, NC.

Cash / Self-Pay

$280

Average discount available for prompt cash payment at this facility.

Insurance Median

$275

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: $280 (270%)

Insurance Median: $275 (265%)

Cash: $280 (270% of Medicare)

Ins. Median: $275 (265% 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 265% of the Medicare baseline (a markup of 165%). 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
First Health	$187	180%
Multiplan/Phcs/Beech Street	$198	191%
Blue Cross Blue Shield	$200 - $246	193%
Compsych	$219	211%
Ambetter / Centene	$225	217%
United Behavioral Health	$229	221%
Healthsmart	$234	225%
Aetna	$235	226%
Provider Networks Of America	$248	239%
Velocity National Provider Network	$248 - $282	239%
Healthspring	$260	251%
Bright Health	$268 - $330	258%
Humana	$268 - $350	258%
Va Ccn	$268	258%
Cigna	$270	260%
Signature Advantage	$274	264%
Tricare	$277	267%
Senior Community Care	$310	299%
American Behavioral	$325 - $375	313%
Friday Health Plan	$325	313%
Provider Partners Health Plan	$345	332%
Magellan	$348	335%
First Choice Health Network	$350 - $530	337%
Medcost	$355	342%
Behavioral Health System	$360	347%
Beacon	$402	387%
Mines & Associates	$475	458%
6Degrees Health	$710	684%

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 $280.
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 Triangle Springs 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.