CMS Price Transparency Data

Group therapy session

Facility: Glens Falls Hospital

Billing Code: 90853 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90853
Insurance Median: $30
Cash Discount Price: $116
vs. Medicare Baseline: 0.29x Medicare

The contracted insurance negotiated median rate for a Group therapy session at Glens Falls Hospital is $30. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $116. Compared to the federal Medicare reimbursement reference rate of $103.79, this hospital’s rate is 0.29x the Medicare baseline. Located in 100 Park Street, Glens Falls, NY.

Cash / Self-Pay

$116

Average discount available for prompt cash payment at this facility.

Insurance Median

$30

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: $116 (112%)

Insurance Median: $30 (29%)

Cash: $116 (112% of Medicare)

Ins. Median: $30 (29% 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	$12 - $23	12%
Cdphp	$16 - $199	15%
Emblem Health Ghi	$18 - $28	17%
Medicare (plans)	$18 - $28	17%
Tricare	$18 - $28	17%
UnitedHealthcare	$18 - $39	17%
Mvp	$20 - $186	19%
Cigna	$21 - $47	20%
Blue Shield Highmark	$23 - $30	22%
Aetna	$24 - $111	23%
Blue Cross Blue Shield	$24 - $407	23%
Fidelis	$24 - $199	23%
Blue Shield	$36 - $74	35%
Hamaspik	$77 - $188	74%
Nascentia Health Options	$77 - $188	74%
Emblem	$95 - $232	92%
Empire Plan Nyship	$101 - $407	97%
Multiplan	$101 - $246	97%
Magnacare	$109 - $218	105%
Mvp Commercial	$171 - $422	165%

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 $116.
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 Glens Falls 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.