CMS Price Transparency Data

Group therapy session

Facility: Franklin Woods Community Hospital

Billing Code: 90853 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90853
Insurance Median: $96
Cash Discount Price: $50
vs. Medicare Baseline: 0.92x Medicare

The contracted insurance negotiated median rate for a Group therapy session at Franklin Woods Community Hospital is $96. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $50. Compared to the federal Medicare reimbursement reference rate of $103.79, this hospital’s rate is 0.92x the Medicare baseline. Located in 300 Med Tech Parkway, Johnson City, TN.

Cash / Self-Pay

$50

Average discount available for prompt cash payment at this facility.

Insurance Median

$96

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: $50 (48%)

Insurance Median: $96 (92%)

Cash: $50 (48% of Medicare)

Ins. Median: $96 (92% 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
Blue Cross Blue Shield	$27 - $347	26%
UnitedHealthcare	$51 - $92	49%
Amerigroup	$60 - $92	58%
Aetna	$92 - $361	89%
First Health Coventry	$92	89%
Humana	$92	89%
Managed Medicaire	$92	89%
Medicare (plans)	$92	89%
Sentara Health	$92 - $96	89%
United Mine Workers Of America	$92	89%
Molina Healthcare	$96 - $361	92%
Cigna	$97 - $160	93%
Devoted Health Plan	$97	93%
Nhc Advantage	$97	93%
Wellcare	$98 - $331	94%
Ambetter / Centene	$201	194%
Medcost	$281	271%
Seven Corners, Inc.	$331	319%
Optima Health	$347	334%

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 $50.
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 Franklin Woods Community 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.