CMS Price Transparency Data

Group therapy session

Facility: Harlem Hospital Center

Billing Code: 90853 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90853
Insurance Median: $111
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.07x Medicare

The contracted insurance negotiated median rate for a Group therapy session at Harlem Hospital Center is $111. 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 1.07x the Medicare baseline. Located in 506 Lenox Avenue, New York, NY.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$111

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: $111 (107%)

Ins. Median: $111 (107% 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
Healthfirst	$21 - $225	20%
Emblem	$26 - $137	25%
Fidelis	$26 - $225	25%
Wellcare	$29	28%
United Behavioral Health	$65 - $110	63%
Aetna	$66 - $666	64%
Carelon	$77 - $407	74%
Metroplus	$93 - $225	90%
Amidacare	$100	96%
Blue Cross Blue Shield	$100 - $434	96%
Senior Whole Health	$100	96%
United	$100 - $206	96%
Affinity	$102 - $225	98%
Carelon (Amida Care)	$102	98%
Vnsny	$102 - $109	98%
Elderplan	$109	105%
Vaccn	$109	105%
Centers Plan For Healthy Living	$114	110%
Centerlight	$129	124%
Oxford	$129 - $155	124%
Oscar	$164	158%
Cigna	$193	186%
Magnacare	$193	186%
Multiplan	$206	198%
Local 1199	$219	211%
Villagecare Max	$219	211%

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 Harlem Hospital Center 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.