CMS Price Transparency Data

Group therapy session

Facility: St Clair Hospital

Billing Code: 90853 (CPT)

The BaseRate · fair price medium confidence

A fair price for this

$78

about 0.8× the $104 Medicare rate · typically $31–$114

modeled estimate · not a bill or quote

What this hospital charges insurers

$221

Well above the fair price

about $143 over the fair price · 2.1× Medicare

Medicare pays $104 Fair price $78 This hospital $221 Cash price $64 Hospital's list price $256

How we calculate the fair BaseRate →

How this hospital compares to other PA hospitals

Highest price of the 9 PA hospitals we have prices for — worth calling around.

Cheapest $16 Priciest $221

Black dot = this hospital, among the 9 PA hospitals with a price for this procedure. Full list below.

A fair price for a Group therapy session is about $78 (about 0.8× the $104 Medicare rate). St Clair Hospital charges insurers about $221, or about $64 in cash — well above the fair price. Located in Pittsburgh, PA.

This price is above the fair BaseRate — you may be able to pay less

Ask the hospital for the cash / self-pay price, check whether you qualify for financial assistance, or negotiate the bill down toward the fair price of about $78. Many patients pay well below the first number they’re quoted — the checklists below walk you through it.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

5 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Cigna✓ Humana Kaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$99 - $325	95%
Blue Cross Blue Shieldmajor	$88 - $221	85%
Aetnamajor	$102 - $265	98%
Cignamajor	$103 - $227	99%
Humanamajor	$99	95%
AmeriHealth	$99	95%
Geisinger	$102	98%
HealthPartners	$104	100%
UPMC Health Plan	$58 - $212	56%
+ 3 smaller / regional plans	$103 - $237

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price (about 64), before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the CPT code on your bill matches exactly: 90853.

Insurance Before you use insurance

Call your insurance company to confirm St Clair Hospital is in-network.
Ask your insurer whether prior approval is required for CPT code 90853.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at St Clair Hospital

Compare: Group therapy session at other PA hospitals

Insurance negotiated median for the same procedure, sorted lowest first.