CMS Price Transparency Data

Group therapy session

Facility: Highland Hospital

Billing Code: 90853 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90853
Insurance Median: $49
Cash Discount Price: Unavailable
vs. Medicare Baseline: 0.47x Medicare

The contracted insurance negotiated median rate for a Group therapy session at Highland Hospital is $49. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $103.79, this hospital’s rate is 0.47x the Medicare baseline. Located in 1000 South Avenue, Rochester, NY.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$49

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%)

Insurance Median: $49 (47%)

Ins. Median: $49 (47% 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
Medicaid / KanCare	$11 - $160	11%
Aetna	$20 - $142	19%
Excellus Bc/Bs [2201]	$20 - $49	19%
Medicare (plans)	$20 - $152	19%
Amerigroup (Bswny Alternate) [1720]	$21 - $160	20%
Excellus Bc/Bs [2201], Bc/Bs Out Of Area [2401]	$21 - $91	20%
Excellus [2201]	$21	20%
UnitedHealthcare	$21 - $160	20%
Elderplan [1316]	$24 - $28	23%
Humana	$24 - $140	23%
Icircle [1728]	$24 - $28	23%
Martins Point [1205]	$24 - $127	23%
Nascentia [1729]	$24 - $28	23%
Highmark Bc/Bs Of Western Ny [5143]	$25 - $30	24%
Fidelis [5155]	$29 - $160	28%
Independent Health [5156]	$39 - $48	38%
Mvp [2900]	$42 - $309	40%
Molina Healthcare [5189], Molina Healthcare [1723]	$52 - $160	50%
Cigna	$55 - $215	53%
Capital District Physicians Health Plan (Cdphp) [5149]	$58 - $89	56%
Blue Cross Blue Shield	$127 - $181	122%

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 $X.
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 Highland 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.