CMS Price Transparency Data

Group therapy session

Facility: Montefiore New Rochelle Hospital

Billing Code: 90853 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90853
Insurance Median: $76
Cash Discount Price: Unavailable
vs. Medicare Baseline: 0.73x Medicare

The contracted insurance negotiated median rate for a Group therapy session at Montefiore New Rochelle Hospital is $76. 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 0.73x the Medicare baseline. Located in 16 Guion Place, New Rochelle, NY.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$76

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: $76 (73%)

Ins. Median: $76 (73% 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
UnitedHealthcare	$24 - $109	23%
Healthfirst	$26 - $109	25%
Molina Healthcare Of Ny Affinity	$62 - $151	60%
Amidacare	$63 - $115	61%
Emblem	$63 - $131	61%
Empire	$63 - $282	61%
Fidelis	$63 - $109	61%
Medicaid / KanCare	$63	61%
Metroplus	$63 - $142	61%
Mvp	$63 - $130	61%
Wellcare	$64 - $112	62%
Hamaspik	$66 - $118	64%
Vnsny Choice	$73 - $109	70%
Vnsny Select Health	$73	70%
Villagecaremax	$109	105%
Partners_Health_Plan	$115	111%
Humana	$120	116%
Centerlight	$175	169%
Aetna	$303 - $339	292%

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 Montefiore New Rochelle 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.