CMS Price Transparency Data

Group therapy session

Facility: Mc Donough District Hospital

Billing Code: 90853 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90853
Insurance Median: $143
Cash Discount Price: $99
vs. Medicare Baseline: 1.38x Medicare

The contracted insurance negotiated median rate for a Group therapy session at Mc Donough District Hospital is $143. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $99. Compared to the federal Medicare reimbursement reference rate of $103.79, this hospital’s rate is 1.38x the Medicare baseline. Located in 525 East Grant Street, Macomb, IL.

Cash / Self-Pay

$99

Average discount available for prompt cash payment at this facility.

Insurance Median

$143

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: $99 (95%)

Insurance Median: $143 (138%)

Cash: $99 (95% of Medicare)

Ins. Median: $143 (138% 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
Health Alliance	$15 - $150	14%
Hfn	$21 - $151	20%
UnitedHealthcare	$21 - $151	20%
Aetna	$24 - $296	23%
Humana	$24 - $296	23%
Medicaid / KanCare	$24 - $296	23%
Medicare (plans)	$24 - $103	23%
Meridian	$24 - $103	23%
Molina	$24 - $168	23%
Mutual Medical	$24 - $168	23%
Veteran Affairs	$24 - $103	23%
Tricare	$96	92%
Springfield Health	$134 - $138	129%
Consociate	$139 - $143	134%
Trilogy	$139 - $143	134%
Blue Choice	$147 - $151	142%
Current Health	$147 - $151	142%
Healthlink	$147 - $158	142%
Preferred Plan	$155 - $160	149%
Blue Cross Blue Shield	$163 - $296	157%

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 $99.
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 Mc Donough District 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.