CMS Price Transparency Data

Group therapy session

Facility: Lecom Medical Center and Behavioral Health Pav

Billing Code: 90853 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90853
Insurance Median: $134
Cash Discount Price: $134
vs. Medicare Baseline: 1.29x Medicare

The contracted insurance negotiated median rate for a Group therapy session at Lecom Medical Center and Behavioral Health Pav is $134. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $134. Compared to the federal Medicare reimbursement reference rate of $103.79, this hospital’s rate is 1.29x the Medicare baseline. Located in 5515 Peach Street, Erie, PA.

Cash / Self-Pay

$134

Average discount available for prompt cash payment at this facility.

Insurance Median

$134

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: $134 (129%)

Insurance Median: $134 (129%)

Cash: $134 (129% of Medicare)

Ins. Median: $134 (129% 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
UnitedHealthcare	$27	26%
Upmc_Commercial	$45	43%
Upmc_For_Life	$45	43%
Upmc_For_Life_Hmo_Premier_Rx	$45	43%
Upmc_Partner	$45	43%
Upmc_Value	$45	43%
Upmc_Value_Select	$45	43%
Blue Cross Blue Shield	$105 - $148	101%
Healthchoice_Berks	$134	129%
Healthchoice_Blair	$134	129%
Healthchoice_Carbon_Monroe_Pike	$134	129%
Healthchoice_Chester	$134	129%
Healthchoice_Erie	$134	129%
Healthchoice_Lycoming_Clinton	$134	129%
Healthchoice_Northcentral	$134	129%
Healthchoice_Northeast	$134	129%
Healthchoice_Somerset_Bedford	$134	129%
Healthchoice_York_Adams	$134	129%
Medicare (plans)	$134	129%
Aetna	$147	142%
Cigna	$184	177%

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 $134.
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 Lecom Medical Center and Behavioral Health Pav 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.