CMS Price Transparency Data

Group therapy session

Facility: Community Hospital of Staunton

Billing Code: 90853 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90853
Insurance Median: $217
Cash Discount Price: $134
vs. Medicare Baseline: 2.09x Medicare

The contracted insurance negotiated median rate for a Group therapy session at Community Hospital of Staunton is $217. 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 2.09x the Medicare baseline. Located in 400 N Caldwell St, Staunton, IL.

Cash / Self-Pay

$134

Average discount available for prompt cash payment at this facility.

Insurance Median

$217

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: $217 (209%)

Cash: $134 (129% of Medicare)

Ins. Median: $217 (209% 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 209% of the Medicare baseline (a markup of 109%). 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
Tricare	$28 - $78	27%
Medicare (plans)	$30 - $80	29%
Clear Spring Health Ma	$31 - $82	30%
Self Pay	$134	129%
Cigna	$173	167%
Blue Cross Blue Shield	$201 - $268	194%
Healthlink	$201 - $228	194%
Health Alliance Commercial	$214 - $268	206%
Aetna	$217 - $268	209%
Multiplan/Phcs	$228	220%
Beech Street	$244	235%
Medicaid / KanCare	$268 - $487	258%
UnitedHealthcare	$268	258%

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 Community Hospital of Staunton 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.