CMS Price Transparency Data

Group therapy session

Facility: St John's Episcopal Hospital at South Shore

Billing Code: 90853 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90853
Insurance Median: $127
Cash Discount Price: $289
vs. Medicare Baseline: 1.22x Medicare

The contracted insurance negotiated median rate for a Group therapy session at St John's Episcopal Hospital at South Shore is $127. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $289. Compared to the federal Medicare reimbursement reference rate of $103.79, this hospital’s rate is 1.22x the Medicare baseline. Located in 327 Beach 19Th Street, Far Rockaway, NY.

Cash / Self-Pay

$289

Average discount available for prompt cash payment at this facility.

Insurance Median

$127

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: $289 (278%)

Insurance Median: $127 (122%)

Cash: $289 (278% of Medicare)

Ins. Median: $127 (122% 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
1199 National Benefit Fund	$35	34%
Aetna	$41 - $178	40%
Healthfirst	$105 - $285	101%
Blue Cross Blue Shield	$119 - $149	115%
Vns	$120 - $127	116%
Centerlight	$127	122%
Centers Plan For Healthy Living	$127	122%
Elderplan	$127	122%
Emblem Health	$127	122%
Fidelis	$127	122%
Hamaspik	$127	122%
Humana	$127	122%
Longevity	$127	122%
Lucida	$127	122%
Metroplus	$127	122%
UnitedHealthcare	$127	122%
Village Care Max	$127	122%
Wellcare	$127	122%
Molina	$139	134%

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 $289.
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 Episcopal Hospital at South Shore 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.