CMS Price Transparency Data

Group therapy session

Facility: St Mary's Healthcare

Billing Code: 90853 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90853
Insurance Median: $103
Cash Discount Price: $94
vs. Medicare Baseline: 0.99x Medicare

The contracted insurance negotiated median rate for a Group therapy session at St Mary's Healthcare is $103. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $94. Compared to the federal Medicare reimbursement reference rate of $103.79, this hospital’s rate is 0.99x the Medicare baseline. Located in 427 Guy Park Avenue, Amsterdam, NY.

Cash / Self-Pay

$94

Average discount available for prompt cash payment at this facility.

Insurance Median

$103

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: $94 (91%)

Insurance Median: $103 (99%)

Cash: $94 (91% of Medicare)

Ins. Median: $103 (99% 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
Carelon_Commercial	$52 - $398	50%
Carelon_Empire	$52 - $383	50%
Medicaid / KanCare	$52 - $58	50%
UnitedHealthcare	$52	50%
Cdphp_Commercial	$72 - $144	69%
Excellus_Commercial	$76 - $152	73%
Aetna	$77 - $154	74%
Emblem_Commercial	$77 - $154	74%
Humana	$103 - $133	99%
Medicare (plans)	$103 - $142	99%
Va	$103 - $127	99%
Tricare	$127	122%
Blue Cross Blue Shield	$131 - $185	126%

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 $94.
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 Healthcare 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.