CMS Price Transparency Data

Group therapy session

Facility: Sweeny Community Hospital

Billing Code: 90853 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90853
Insurance Median: $168
Cash Discount Price: $155
vs. Medicare Baseline: 1.62x Medicare

The contracted insurance negotiated median rate for a Group therapy session at Sweeny Community Hospital is $168. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $155. Compared to the federal Medicare reimbursement reference rate of $103.79, this hospital’s rate is 1.62x the Medicare baseline. Located in 305 North McKinney, Sweeny, TX.

Cash / Self-Pay

$155

Average discount available for prompt cash payment at this facility.

Insurance Median

$168

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: $155 (149%)

Insurance Median: $168 (162%)

Cash: $155 (149% of Medicare)

Ins. Median: $168 (162% 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	$78 - $129	75%
Evercare Mcaid	$129	124%
Aetna	$150 - $207	145%
Amerigroup Mcr Adv - All Other Plans	$150	145%
Community Hlth Choice Him - All Other Plans	$150	145%
Coventry Mcr Adv	$150	145%
Molina Mcr Adv - All Other Plans	$150	145%
Superior Hp Mcr Adv-All Other Plans	$150	145%
Wellcare Mcare - All Plans	$150	145%
Care Improvement Mcr - All Plans	$151	145%
Choicecare Mcr Adv - All Plans	$151	145%
Cigna	$168	162%
Community Hlth Choice Star	$182	175%
Molina Mcaid	$182	175%
Superior Hp Mcaid	$182	175%
Tx Chlidrens Hp Mcaid - All Plans	$182	175%
Tx True Choice Mcaid - All Plans	$182	175%
Beech Street - All Plans	$194	187%
Community Care Network - All Plans	$207	199%
UnitedHealthcare	$207	199%
Galaxy Health Network - All Plans	$233	224%
Multiplan - All Plans	$233	224%
Evercare Mcr Adv - All Other Plans	$251	242%
Amerigroup Mcaid	$258	249%

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 $155.
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 Sweeny 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.