CMS Price Transparency Data

Group therapy session

Facility: St Mary's General Hospital

Billing Code: 90853 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90853
Insurance Median: $120
Cash Discount Price: $120
vs. Medicare Baseline: 1.16x Medicare

The contracted insurance negotiated median rate for a Group therapy session at St Mary's General Hospital is $120. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $120. Compared to the federal Medicare reimbursement reference rate of $103.79, this hospital’s rate is 1.16x the Medicare baseline. Located in 350 Boulevard, Passaic, NJ.

Cash / Self-Pay

$120

Average discount available for prompt cash payment at this facility.

Insurance Median

$120

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: $120 (116%)

Insurance Median: $120 (116%)

Cash: $120 (116% of Medicare)

Ins. Median: $120 (116% 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
Horizon	$28 - $213	27%
Ubh	$28	27%
UnitedHealthcare	$28 - $120	27%
Amerihealth	$32	31%
Humana	$96	92%
Aetna	$120 - $255	116%
Clover Health	$120	116%
Medicare (plans)	$120	116%
Tricare	$120	116%
Wellcare	$120 - $162	116%
Wellpoint Amerigroup	$120	116%
Ally-Align (Fka Spartan Plan Nj, Inc.)	$126	121%
Employer Direct Healthcare	$168	162%
Cigna	$176	170%
Fairprice Healthcare Holdings	$192	185%
Coventry	$240	231%

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 $120.
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 St Mary's General 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.