CMS Price Transparency Data

Group therapy session

Facility: Robert Wood Johnson University Hospital - Somerset

Billing Code: 90853 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90853
Insurance Median: $382
Cash Discount Price: $111
vs. Medicare Baseline: 3.68x Medicare

The contracted insurance negotiated median rate for a Group therapy session at Robert Wood Johnson University Hospital - Somerset is $382. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $111. Compared to the federal Medicare reimbursement reference rate of $103.79, this hospital’s rate is 3.68x the Medicare baseline. Located in 110 Rehill Ave, Somerville, NJ.

Cash / Self-Pay

$111

Average discount available for prompt cash payment at this facility.

Insurance Median

$382

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: $111 (107%)

Insurance Median: $382 (368%)

Cash: $111 (107% of Medicare)

Ins. Median: $382 (368% 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 368% of the Medicare baseline (a markup of 268%). 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
Blue Cross Blue Shield	$31 - $598	30%
Wellpoint	$33 - $101	32%
Fidelis Care	$97 - $101	93%
Clover Health	$101	97%
Aetna	$101 - $543	97%
Humana	$101	97%
Emblem Health	$177	171%
Wellcare	$201	194%
Cigna	$343 - $459	330%
First Health	$392	378%
Qualcare Inc	$497	479%
Amerihealth	$560	540%

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 $111.
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 Robert Wood Johnson University Hospital - Somerset 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.