CMS Price Transparency Data

Group therapy session

Facility: Prisma Health Tuomey Hospital

Billing Code: 90853 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90853
Insurance Median: $160
Cash Discount Price: $176
vs. Medicare Baseline: 1.54x Medicare

The contracted insurance negotiated median rate for a Group therapy session at Prisma Health Tuomey Hospital is $160. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $176. Compared to the federal Medicare reimbursement reference rate of $103.79, this hospital’s rate is 1.54x the Medicare baseline. Located in 129 N Washington St, Sumter, SC.

Cash / Self-Pay

$176

Average discount available for prompt cash payment at this facility.

Insurance Median

$160

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: $176 (170%)

Insurance Median: $160 (154%)

Cash: $176 (170% of Medicare)

Ins. Median: $160 (154% 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
Medicaid / KanCare	$26 - $110	25%
UnitedHealthcare	$26 - $244	25%
Prisma Health Seniorcare Pace - Midlands [5400]	$39 - $86	38%
Prisma Health Seniorcare Pace-Upstate [5200]	$39 - $86	38%
Promise Health Plan Contracted [2401]	$60 - $450	58%
Orangeburg Senior Helping Center Pace [5401]	$68 - $148	66%
Blue Cross Blue Shield	$79 - $464	76%
Bluechoice [810]	$79 - $378	76%
Tricare	$87	84%
Bob Jones Univ-Pai [821]	$102 - $375	98%
Aetna	$109 - $292	105%
Golden Rule Insurance Company [2991]	$109 - $244	105%
Meritain Health Contracted [2200]	$109 - $292	105%
Oxford Health Plans [2992]	$109 - $244	105%
Zzumr-Salt Lake City Ut [3169]	$109 - $244	105%
Humana	$112 - $278	108%
Preferred Administrators Contracted [2839]	$119 - $259	115%
Medcost [2940]	$126 - $307	121%
Atlantic Packaging Contracted [4833]	$128 - $278	123%
Cigna	$130 - $284	125%
Aps Healthcare System [2981]	$136 - $296	131%
Multiplan/Phcs Contracted [2950]	$151 - $329	145%
Vsp Vision Care [2986]	$153 - $333	147%
First Health Contracted [2952]	$158 - $344	152%
Furman Int/Allen University Student [2951]	$158 - $344	152%
Quiktrip-First Health [3067]	$158 - $344	152%
Companion Benefit Alternatives [2983]	$162 - $351	156%
Carelon Behavioral Health [3180]	$175 - $375	169%
Scdc-Sc Dept Of Corrections [7232]	$208 - $464	200%
Planned Administrators [820]	$379	365%

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 $176.
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 Prisma Health Tuomey Hospital 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.