CMS Price Transparency Data

Group therapy session

Facility: Mc Donough District Hospital

Billing Code: 90853 (CPT)

The BaseRate · fair price medium confidence

A fair price for this

$48

about 0.5× the $104 Medicare rate · typically $26–$81

modeled estimate · not a bill or quote

What this hospital charges insurers

$28

Below the fair price — a good deal

about $20 under the fair price · 0.3× Medicare

Medicare pays $104 Fair price $48 This hospital $28 Cash price $99 Hospital's list price $166

How we calculate the fair BaseRate →

How this hospital compares to other IL hospitals

A typical price — 3 charge more and 4 charge less, among the 9 IL hospitals compared.

Cheapest $24 Priciest $34

Black dot = this hospital, among the 9 IL hospitals with a price for this procedure. Full list below.

⚠ The cash price looks unusually high next to the insurance price — it may be the full list price, not a real cash discount. Call to confirm the self-pay rate.

A fair price for a Group therapy session is about $48 (about 0.5× the $104 Medicare rate). Mc Donough District Hospital charges insurers about $28, or about $99 in cash — below the fair price — a good deal. Located in Macomb, IL.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

4 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Humana CignaKaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$21 - $151	20%
Blue Cross Blue Shieldmajor	$163 - $296	157%
Aetnamajor	$24 - $296	23%
Humanamajor	$24 - $296	23%
HealthLink	$147 - $158	142%
Meridian	$24 - $103	23%
Molina	$24 - $168	23%
+ 9 smaller / regional plans	$15 - $168

Government programs also on file: Medicare, Medicaid, Military & VA.

Excludes 1 rental-network / third-party entry (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price (about 99), before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the CPT code on your bill matches exactly: 90853.

Insurance Before you use insurance

Call your insurance company to confirm Mc Donough District Hospital is in-network.
Ask your insurer whether prior approval is required for CPT code 90853.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at Mc Donough District Hospital

Compare: Group therapy session at other IL hospitals

Insurance negotiated median for the same procedure, sorted lowest first.