CMS Price Transparency Data

Group therapy session

Facility: St Joseph's University Medical Center Inc

Billing Code: 90853 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 90853
  • Insurance Median: $121
  • Cash Discount Price: $436
  • vs. Medicare Baseline: 1.17x Medicare
The contracted insurance negotiated median rate for a Group therapy session at St Joseph's University Medical Center Inc is $121. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $436. Compared to the federal Medicare reimbursement reference rate of $103.79, this hospital’s rate is 1.17x the Medicare baseline. Located in 703 Main St, Paterson, NJ.
Cash / Self-Pay
$436

Average discount available for prompt cash payment at this facility.

Insurance Median
$121

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: $436 (420%)
Insurance Median: $121 (117%)
Cash: $436 (420% of Medicare)
Ins. Median: $121 (117% 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.

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
Fidelis Care of New Jersey $20 - $127 19%
UnitedHealthcare $20 - $279 19%
Aetna $26 - $246 25%
Ambetter / Centene $26 - $181 25%
Amerihealth $26 - $278 25%
Clover Health $26 - $121 25%
Horizon New Jersey Total Care $26 - $121 25%
Wellpoint $26 - $121 25%
Blue Cross Blue Shield $35 - $344 34%
Multiplan $39 - $327 38%
Amerihealth Behavioral Health $45 - $63 43%
Consumer Health Network $46 - $392 44%
Private Healthcare Systems $57 - $283 55%
Horizon New Jersey Health $74 - $135 71%
Cigna $88 - $436 85%
Longevity Health Plan $139 134%
Oxford $279 269%
Magnacare $305 294%
Oscar $411 396%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 703 Main St, Paterson, NJ 07503
  • CMS Rating: ★★★☆☆
  • Ownership Type: Voluntary non-profit - Church
  • Hospital Type: Acute Care Hospitals