CMS Price Transparency Data

Group therapy session

Facility: Saratoga Hospital

Billing Code: 90853 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90853
Insurance Median: $28
Cash Discount Price: $44
vs. Medicare Baseline: 0.27x Medicare

The contracted insurance negotiated median rate for a Group therapy session at Saratoga Hospital is $28. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $44. Compared to the federal Medicare reimbursement reference rate of $103.79, this hospital’s rate is 0.27x the Medicare baseline. Located in 211 Church Street, Saratoga Springs, NY.

Cash / Self-Pay

$44

Average discount available for prompt cash payment at this facility.

Insurance Median

$28

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: $44 (42%)

Insurance Median: $28 (27%)

Cash: $44 (42% of Medicare)

Ins. Median: $28 (27% 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
Multiplan	$8 - $236	8%
Mvp Commercial	$8 - $208	8%
Empire Plan Nyship	$9 - $236	9%
UnitedHealthcare	$9 - $250	9%
Magnacare	$10 - $264	10%
Blue Shield	$11 - $105	11%
Medicaid / KanCare	$12 - $23	12%
Cdphp	$16 - $186	15%
Blue Cross Blue Shield	$18 - $153	17%
Fidelis	$18 - $186	17%
Medicare (plans)	$18 - $28	17%
Tricare	$18 - $28	17%
Hamaspik	$20 - $195	19%
Mvp	$20 - $47	19%
Cigna	$21 - $47	20%
Blue Shield Highmark	$23 - $31	22%
Aetna	$24 - $29	23%
Emblem Health Ghi	$24 - $30	23%
Nascentia Health Options	$38	37%
Emblem	$39 - $109	38%
Mvp Essential Plan	$83 - $166	80%
Mvp Govt Programs	$83	80%

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 $44.
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 Saratoga 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.