CMS Price Transparency Data

Group therapy session

Facility: Blount Memorial Hospital

Billing Code: 90853 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90853
Insurance Median: $159
Cash Discount Price: $87
vs. Medicare Baseline: 1.53x Medicare

The contracted insurance negotiated median rate for a Group therapy session at Blount Memorial Hospital is $159. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $87. Compared to the federal Medicare reimbursement reference rate of $103.79, this hospital’s rate is 1.53x the Medicare baseline. Located in 907 E Lamar Alexander Parkway, Maryville, TN.

Cash / Self-Pay

$87

Average discount available for prompt cash payment at this facility.

Insurance Median

$159

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: $87 (84%)

Insurance Median: $159 (153%)

Cash: $87 (84% of Medicare)

Ins. Median: $159 (153% 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	$27 - $59	26%
UnitedHealthcare	$27 - $334	26%
Prisma Health Seniorcare Pace - Midlands [5400]	$41 - $89	40%
Prisma Health Seniorcare Pace-Upstate [5200]	$41 - $89	40%
Promise Health Plan Contracted [2401]	$62 - $450	60%
Orangeburg Senior Helping Center Pace [5401]	$71 - $154	68%
Tricare	$86	83%
Cigna	$97 - $250	93%
Blue Cross Blue Shield	$99 - $216	95%
Bob Jones Univ-Pai [821]	$106 - $375	102%
Preferred Administrators Contracted [2839]	$124 - $270	119%
Mvp Health Care [3037]	$129	124%
Medcost [2940]	$131 - $320	126%
Atlantic Packaging Contracted [4833]	$133 - $289	128%
Aps Healthcare System [2981]	$142 - $308	137%
Multiplan/Phcs Contracted [2950]	$158 - $343	152%
Aetna	$159 - $346	153%
Meritain Health Contracted [2200]	$159 - $346	153%
Nippon [2300]	$159 - $346	153%
Vsp Vision Care [2986]	$159 - $346	153%
Companion Benefit Alternatives [2983]	$162 - $351	156%
First Health Contracted [2952]	$165 - $358	159%
Furman Int/Allen University Student [2951]	$165 - $358	159%
Quiktrip-First Health [3067]	$165 - $358	159%
Carelon Behavioral Health [3180]	$175 - $375	169%
Golden Rule Insurance Company [2991]	$334	322%
Oxford Health Plans [2992]	$334	322%

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 $87.
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 Blount Memorial 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.