CMS Price Transparency Data

Group therapy session

Facility: Saint Francis Hospital-Evanston

Billing Code: 90853 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90853
Insurance Median: $112
Cash Discount Price: $108
vs. Medicare Baseline: 1.08x Medicare

The contracted insurance negotiated median rate for a Group therapy session at Saint Francis Hospital-Evanston is $112. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $108. Compared to the federal Medicare reimbursement reference rate of $103.79, this hospital’s rate is 1.08x the Medicare baseline. Located in 355 Ridge Ave, Evanston, IL.

Cash / Self-Pay

$108

Average discount available for prompt cash payment at this facility.

Insurance Median

$112

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: $108 (104%)

Insurance Median: $112 (108%)

Cash: $108 (104% of Medicare)

Ins. Median: $112 (108% 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
Ravenswood Physicians Associates Ipa	$25 - $108	24%
Resurrection Physicians Provider Group Ipa	$25 - $108	24%
UnitedHealthcare	$26 - $240	25%
Blue Cross Blue Shield	$103 - $296	99%
Aetna	$108 - $296	104%
Celtic (Wellcare)	$108	104%
Cigna	$108	104%
Clear Spring Health Of Illinois	$108	104%
Devoted Health	$108	104%
Essential Health Partners	$108 - $125	104%
Humana	$108 - $296	104%
Illinois Physicians Alliance	$108	104%
Longevity Health Plan Of Illinois	$108	104%
Medicare (plans)	$108	104%
Self-Pay	$108	104%
Tricare	$108	104%
Molina	$112 - $311	108%
Zing Health Provider Network	$112	108%
Meridian	$114 - $311	110%
Provider Partners Health Plan (Pphp)	$114	110%
Access Community Health Network	$130	125%
Clifton Health Systems	$168	162%
Ambetter / Centene	$175	169%
Countycare	$296	285%
Medicaid / KanCare	$296	285%
Standard Eapg Logic - Contracts	$296	285%
Healthlink, Inc	$388	374%

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 $108.
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 Saint Francis Hospital-Evanston 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.