CMS Price Transparency Data

Group therapy session

Facility: Kaleida Health

Billing Code: 90853 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90853
Insurance Median: $129
Cash Discount Price: $295
vs. Medicare Baseline: 1.24x Medicare

The contracted insurance negotiated median rate for a Group therapy session at Kaleida Health is $129. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $295. Compared to the federal Medicare reimbursement reference rate of $103.79, this hospital’s rate is 1.24x the Medicare baseline. Located in 100 High Street, Buffalo, NY.

Cash / Self-Pay

$295

Average discount available for prompt cash payment at this facility.

Insurance Median

$129

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: $295 (284%)

Insurance Median: $129 (124%)

Cash: $295 (284% of Medicare)

Ins. Median: $129 (124% 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
Ghi/Emblem Health	$29 - $171	28%
Ghi/Emblem Health - Wchob	$29 - $36	28%
Aetna	$30 - $134	29%
Magnacare	$30 - $44	29%
Magnacare - Wchob	$30 - $44	29%
Univera	$54 - $177	52%
Univera - Wchob	$54 - $172	52%
Independent Health Association	$64 - $202	62%
Independent Health Association - Wchob	$67 - $206	65%
Blue Cross Blue Shield	$86 - $473	83%
Tricare	$120	116%
Wellcare	$132	127%
Fidelis	$137	132%
UnitedHealthcare	$138	133%
Cigna	$148 - $180	143%

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 $295.
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 Kaleida Health 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.