CMS Price Transparency Data

Group therapy session

Facility: St Francis Hospital - the Heart Center

Billing Code: 90853 (CPT)

The BaseRate · fair price medium confidence

A fair price for this

$108

about 1.0× the $104 Medicare rate · typically $46–$191

modeled estimate · not a bill or quote

What this hospital charges insurers

$183

Above the fair price

about $75 over the fair price · 1.8× Medicare

Medicare pays $104 Fair price $108 This hospital $183 Hospital's list price $280

How we calculate the fair BaseRate →

How this hospital compares to other NY hospitals

Highest price of the 9 NY hospitals we have prices for — worth calling around.

Cheapest $24 Priciest $183

Black dot = this hospital, among the 9 NY hospitals with a price for this procedure. Full list below.

A fair price for a Group therapy session is about $108 (about 1.0× the $104 Medicare rate). St Francis Hospital - the Heart Center charges insurers about $183 — above the fair price. Located in Roslyn, NY.

This price is above the fair BaseRate — you may be able to pay less

Ask the hospital for the cash / self-pay price, check whether you qualify for financial assistance, or negotiate the bill down toward the fair price of about $108. Many patients pay well below the first number they’re quoted — the checklists below walk you through it.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

5 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Cigna✓ Humana Kaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$59 - $412	57%
Blue Cross Blue Shieldmajor	$107 - $298	103%
Aetnamajor	$109 - $232	105%
Cignamajor	$140 - $196	135%
Humanamajor	$112	108%
AmeriHealth	$246	237%
Cigna HealthSpring	$109	105%
Fidelis Care	$109 - $412	105%
Independent Health	$109 - $183	105%
MVP Health Care	$109 - $183	105%
Oscar Health	$115	111%
UniCare	$196	189%
WellCare	$120	116%
+ 41 smaller / regional plans	$37 - $412

Government programs also on file: Medicare, Medicaid, Military & VA.

Excludes 7 rental-network / third-party entries (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price, before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the CPT code on your bill matches exactly: 90853.

Insurance Before you use insurance

Call your insurance company to confirm St Francis Hospital - the Heart Center is in-network.
Ask your insurer whether prior approval is required for CPT code 90853.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at St Francis Hospital - the Heart Center

Compare: Group therapy session at other NY hospitals

Insurance negotiated median for the same procedure, sorted lowest first.