CMS Price Transparency Data

Group therapy session

Facility: St John's Riverside Hospital

Billing Code: 90853 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90853
Insurance Median: $126
Cash Discount Price: $420
vs. Medicare Baseline: 1.21x Medicare

The contracted insurance negotiated median rate for a Group therapy session at St John's Riverside Hospital is $126. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $420. Compared to the federal Medicare reimbursement reference rate of $103.79, this hospital’s rate is 1.21x the Medicare baseline. Located in 976 North Broadway, Yonkers, NY.

Cash / Self-Pay

$420

Average discount available for prompt cash payment at this facility.

Insurance Median

$126

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: $420 (405%)

Insurance Median: $126 (121%)

Cash: $420 (405% of Medicare)

Ins. Median: $126 (121% 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
Blue Cross Blue Shield	$82 - $227	79%
Cigna	$107	103%
Fidelis Essential Plans	$107	103%
Medicaid / KanCare	$107	103%
Fidelis Health Benefit Exchange	$120	116%
Aetna	$126 - $3,783	121%
Centers Plan For Healthy Living	$126	121%
Fidelis	$126	121%
Healthfirst	$126	121%
Hip Health Plan	$126	121%
Magnacare	$126	121%
Medicare (plans)	$126	121%
Mvp	$126	121%
Mvp Bhs	$126	121%
Oscar	$126 - $132	121%
Partners Health Plan	$126	121%
United Behavioral Health Of Ny Ipa	$126	121%
Village Caremax	$126	121%
Wellcare	$126	121%
Metroplus Gold	$132	127%
Empire Hmo	$155 - $227	149%
Mvp Individual Exchange.Student Health Plan	$444	428%
Mvp Commercial	$524	505%

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 $420.
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 John's Riverside 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.