CMS Price Transparency Data

Group therapy session

Facility: Ira Davenport Memorial Hospital

Billing Code: 90853 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90853
Insurance Median: $35
Cash Discount Price: $40
vs. Medicare Baseline: 0.34x Medicare

The contracted insurance negotiated median rate for a Group therapy session at Ira Davenport Memorial Hospital is $35. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $40. Compared to the federal Medicare reimbursement reference rate of $103.79, this hospital’s rate is 0.34x the Medicare baseline. Located in 7571 State Route 54, Bath, NY.

Cash / Self-Pay

$40

Average discount available for prompt cash payment at this facility.

Insurance Median

$35

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: $40 (39%)

Insurance Median: $35 (34%)

Cash: $40 (39% of Medicare)

Ins. Median: $35 (34% 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
Empire	$19 - $23	18%
Fidelis Care - Exchange - All Plans	$22	21%
Geisinger - All Plans	$23	22%
Cigna	$25	24%
Mvp Health Plan - All Plans	$25	24%
Independent Health - All Plans	$26	25%
Upmc - All Plans	$27	26%
Pomco Inc - All Plans	$28	27%
Aetna	$30	29%
UnitedHealthcare	$30	29%
Emblem Health - All Plans	$35	34%
Humana	$36 - $109	35%
Martins Point - All Plans	$40	39%
Blue Cross Blue Shield	$58 - $120	56%
Fidelis	$109	105%
Tricare	$109	105%
Amerihealth Caritas Mcr Adv - All Plans	$111	107%
Healthnow - All Plans	$130	125%

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 $40.
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 Ira Davenport Memorial Hospital 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.