CMS Price Transparency Data

Group therapy session

Facility: Ohio State University State Health System

Billing Code: 90853 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90853
Insurance Median: $257
Cash Discount Price: Unavailable
vs. Medicare Baseline: 2.48x Medicare

The contracted insurance negotiated median rate for a Group therapy session at Ohio State University State Health System is $257. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $103.79, this hospital’s rate is 2.48x the Medicare baseline. Located in 410 West 10Th Avenue, Columbus, OH.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$257

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%)

Insurance Median: $257 (248%)

Ins. Median: $257 (248% 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 248% of the Medicare baseline (a markup of 148%). 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
Osu Health Plan	$88 - $719	85%
Aetna	$89 - $1,156	86%
Blue Cross Blue Shield	$89 - $1,346	86%
Medicare (plans)	$89 - $96	86%
Mmo	$89 - $784	86%
Molina	$89 - $148	86%
Upper Ohio Valley	$89 - $949	86%
Humana	$90	87%
Buckeye Community	$91 - $137	88%
Caresource	$93 - $137	90%
Healthspan	$93 - $690	90%
Medigold	$93	90%
Ohio Ppo	$106 - $644	102%
Odrc	$115 - $585	111%
Cigna	$185 - $1,038	178%
Ohiohealth	$185 - $1,078	178%
Lifetrac	$193 - $978	186%
Frontpath	$227 - $1,150	219%
Multiplan	$227 - $1,150	219%
Healthsmart	$256 - $1,294	247%
United	$343 - $941	330%

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 $X.
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 Ohio State University State Health System 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.