CMS Price Transparency Data

Group therapy session

Facility: Ascension Seton Medical Center Austin

Billing Code: 90853 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90853
Insurance Median: $90
Cash Discount Price: Unavailable
vs. Medicare Baseline: 0.87x Medicare

The contracted insurance negotiated median rate for a Group therapy session at Ascension Seton Medical Center Austin is $90. 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 0.87x the Medicare baseline. Located in 1201 W 38Th St, Austin, TX.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$90

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: $90 (87%)

Ins. Median: $90 (87% 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
Champva	$25	24%
Tricare	$67 - $90	65%
Aarp Mc Wellmed	$88	85%
Sendero Chap	$89	86%
Addr Cancer Together	$90	87%
Aetna	$90	87%
Covid Hrsa	$90	87%
Cshcn Cidc	$90	87%
Devoted Health Mcr Replacement	$90	87%
Humana	$90	87%
Medicare (plans)	$90	87%
Research Study	$90	87%
Smarthealth	$90	87%
Superior Allwell	$90	87%
Uhcpcip	$90	87%
Wellcare Med Advantage	$90	87%
UnitedHealthcare	$91	88%
Connected Senior Care	$92	89%
Pphp Mcr Advantage	$94	91%
Tx Independence Hp	$94	91%
Occunet	$126	121%
Sendero Idealcare	$157	151%
Ambetter / Centene	$161	155%

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 Ascension Seton Medical Center Austin 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.