CMS Price Transparency Data

Group therapy session

Facility: Penn State Health St. Joseph

Billing Code: 90853 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90853
Insurance Median: $118
Cash Discount Price: $156
vs. Medicare Baseline: 1.14x Medicare

The contracted insurance negotiated median rate for a Group therapy session at Penn State Health St. Joseph is $118. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $156. Compared to the federal Medicare reimbursement reference rate of $103.79, this hospital’s rate is 1.14x the Medicare baseline. Located in 2500 Bernville Road, Reading, PA.

Cash / Self-Pay

$156

Average discount available for prompt cash payment at this facility.

Insurance Median

$118

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: $156 (150%)

Insurance Median: $118 (114%)

Cash: $156 (150% of Medicare)

Ins. Median: $118 (114% 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
[Amerihealth Caritas]	$88 - $103	85%
[Highmark Wholecare]	$88 - $103	85%
[Geisinger]	$93 - $434	90%
[Health Partners Plans]	$96 - $105	92%
[Pa Health & Wellness]	$97 - $106	93%
[Highmark]	$102 - $562	98%
UnitedHealthcare	$103 - $407	99%
[Cbc]	$103 - $318	99%
[Ibc]	$103 - $299	99%
Aetna	$104 - $307	100%
Humana	$104	100%
[Healthspring]	$104	100%
[Upmc]	$105 - $444	101%
[Point Comfort Underwriters]	$129	124%
Cigna	$369	356%
[Highmark Choice Blue]	$449	433%
[Preferred Healthcare Systems]	$451	435%
[Highmark Aca]	$472	455%
[First Health]	$481	463%
[Multiplan]	$481	463%

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 $156.
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 Penn State Health St. Joseph 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.