CMS Price Transparency Data

Group therapy session

Facility: North Texas Medical Center

Billing Code: 90853 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90853
Insurance Median: $85
Cash Discount Price: $19
vs. Medicare Baseline: 0.82x Medicare

The contracted insurance negotiated median rate for a Group therapy session at North Texas Medical Center is $85. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $19. Compared to the federal Medicare reimbursement reference rate of $103.79, this hospital’s rate is 0.82x the Medicare baseline. Located in 1900 Hospital Blvd, Gainesville, TX.

Cash / Self-Pay

$19

Average discount available for prompt cash payment at this facility.

Insurance Median

$85

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: $19 (18%)

Insurance Median: $85 (82%)

Cash: $19 (18% of Medicare)

Ins. Median: $85 (82% 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
Cigna	$30	29%
Blue Cross Blue Shield	$38 - $85	37%
First Health	$45	43%
Healthcare Highways	$45	43%
Aetna	$47 - $85	45%
Multiplan	$53	51%
Provider Select	$64	62%
Prime Health	$68 - $85	66%
UnitedHealthcare	$69 - $85	66%
90 Degree Benefits	$85	82%
Humana	$85	82%
Molina	$85 - $93	82%
Prominence Health	$85 - $89	82%
Superior	$85 - $93	82%
Wellmed	$85	82%
Wellpoint	$85	82%
Providers Partners Health Plan	$89	86%

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 $19.
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 North Texas Medical Center 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.