CMS Price Transparency Data

Group therapy session

Facility: Cass County Memorial Hospital

Billing Code: 90853 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90853
Insurance Median: $313
Cash Discount Price: $515
vs. Medicare Baseline: 3.02x Medicare

The contracted insurance negotiated median rate for a Group therapy session at Cass County Memorial Hospital is $313. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $515. Compared to the federal Medicare reimbursement reference rate of $103.79, this hospital’s rate is 3.02x the Medicare baseline. Located in 1501 East Tenth Street, Atlantic, IA.

Cash / Self-Pay

$515

Average discount available for prompt cash payment at this facility.

Insurance Median

$313

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: $515 (496%)

Insurance Median: $313 (302%)

Cash: $515 (496% of Medicare)

Ins. Median: $313 (302% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 302% of the Medicare baseline (a markup of 202%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Midlands Choice Medica Mcr	$147	142%
Wellmark Hmo	$156	150%
Wellmark Ppo - All Other Plans	$172	166%
Triwest - All Plans	$299	288%
Aetna	$309 - $698	298%
Amerigroup Mcr Adv - All Other Plans	$309	298%
Tricare	$309	298%
UnitedHealthcare	$309	298%
Va Ccn - All Plans	$309	298%
Wellmark Mcr Adv	$312	301%
Iowa Total Care Mcaid	$315	303%
Iowa Total Care Mcr	$315	303%
Molina Mcaid - All Plans	$315	303%
American Hlth Mcr Adv - All Plans	$318	306%
Medicaid / KanCare	$318	306%
Iowa Total Care Comm - All Other Plans	$340	328%
Midlands Choice New Bus	$478	461%
Midlands Choice Pho (Ppo) - All Other Plans	$662	638%
Multiplan - All Plans	$698	673%

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 $515.
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 Cass County 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.