CMS Price Transparency Data

Group therapy session

Facility: UPMC Chautauqua at Wca

Billing Code: 90853 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90853
Insurance Median: $56
Cash Discount Price: $44
vs. Medicare Baseline: 0.54x Medicare

The contracted insurance negotiated median rate for a Group therapy session at UPMC Chautauqua at Wca is $56. 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 0.54x the Medicare baseline. Located in 207 Foote Avenue, Jamestown, NY.

Cash / Self-Pay

$44

Average discount available for prompt cash payment at this facility.

Insurance Median

$56

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: $56 (54%)

Cash: $44 (42% of Medicare)

Ins. Median: $56 (54% 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
Univera	$25 - $72	24%
United Behavioral Health	$35	34%
Aetna	$38 - $48	37%
Geisinger	$41	40%
Ccbhn	$44	42%
Magnacare	$44 - $56	42%
Upmc Health Plan	$44	42%
Fidelis	$45 - $155	43%
UnitedHealthcare	$47 - $69	45%
Humana	$56 - $59	54%
Multiplan	$56	54%
Ghi/Emblem Health	$59	57%
Statewide Independent Ppo	$65	63%
Affordable First Health	$67	65%
Beacon	$69	66%
Blue Cross Blue Shield	$69 - $114	66%
Molina Healthcare Of Ny	$69 - $155	66%
Corvel	$93	90%
Independent Health	$107 - $136	103%

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 UPMC Chautauqua at Wca 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.