CMS Price Transparency Data

Group therapy session

Facility: Charleston Area Medical Center

Billing Code: 90853 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90853
Insurance Median: $31
Cash Discount Price: $231
vs. Medicare Baseline: 0.30x Medicare

The contracted insurance negotiated median rate for a Group therapy session at Charleston Area Medical Center is $31. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $231. Compared to the federal Medicare reimbursement reference rate of $103.79, this hospital’s rate is 0.30x the Medicare baseline. Located in 501 Morris Street, Charleston, WV.

Cash / Self-Pay

$231

Average discount available for prompt cash payment at this facility.

Insurance Median

$31

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: $231 (223%)

Insurance Median: $31 (30%)

Cash: $231 (223% of Medicare)

Ins. Median: $31 (30% 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
Aetna	$19 - $48	18%
The Health Plan Of West Virginia Inc.	$19 - $47	18%
Unicare Health Plan Of West Virginia Inc.	$19	18%
Blue Cross Blue Shield	$27 - $30	26%
Choicecare Network	$29 - $31	28%
Triwest Va	$29	28%
Optimum Choice Inc.	$30	29%
UnitedHealthcare	$30	29%
West Virginia Senior Advantage Inc.	$31	30%
City Of Charleston	$38	37%
Naphcare	$40	39%
Integrated Medical Solutions	$43	41%
Caresource	$44	42%
Tricare	$139	134%
Three Rivers Providers Network	$224	216%
Healthsmart	$226	218%
Multiplan	$226	218%
Cigna	$229	221%

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 $231.
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 Charleston Area 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.