CMS Price Transparency Data

Group therapy session

Facility: Ocean Medical Center

Billing Code: 90853 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90853
Insurance Median: $269
Cash Discount Price: $97
vs. Medicare Baseline: 2.59x Medicare

The contracted insurance negotiated median rate for a Group therapy session at Ocean Medical Center is $269. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $97. Compared to the federal Medicare reimbursement reference rate of $103.79, this hospital’s rate is 2.59x the Medicare baseline. Located in 425 Jack Martin Blvd, Brick, NJ.

Cash / Self-Pay

$97

Average discount available for prompt cash payment at this facility.

Insurance Median

$269

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: $97 (93%)

Insurance Median: $269 (259%)

Cash: $97 (93% of Medicare)

Ins. Median: $269 (259% 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 259% of the Medicare baseline (a markup of 159%). 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
Karna	$39 - $40	38%
Aetna	$59 - $395	57%
Clover	$74	71%
Seoul Medical Group	$80 - $95	77%
Amerigroup	$92	89%
Horizon	$92 - $341	89%
Vaccn	$92 - $101	89%
Wellcare	$92 - $101	89%
United Community/Americhoice	$97 - $106	93%
Blue Cross Blue Shield	$101 - $154	97%
UnitedHealthcare	$121 - $285	117%
Qualcare	$136 - $363	131%
Oxford	$272	262%
Activecare First McO	$308 - $351	297%
Intergroup	$308	297%
Bergen Risk	$310	299%
Multiplan - PHCS	$351 - $374	338%
Cigna	$352 - $424	339%
Prime Health	$352	339%
Amerihealth	$355 - $402	342%
Brighton Health Plan	$372	358%

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 $97.
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 Ocean 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.