CMS Price Transparency Data

Group therapy session

Facility: Carle Eureka Hospital

Billing Code: 90853 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90853
Insurance Median: $51
Cash Discount Price: $165
vs. Medicare Baseline: 0.49x Medicare

The contracted insurance negotiated median rate for a Group therapy session at Carle Eureka Hospital is $51. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $165. Compared to the federal Medicare reimbursement reference rate of $103.79, this hospital’s rate is 0.49x the Medicare baseline. Located in 101 S Major St, Eureka, IL.

Cash / Self-Pay

$165

Average discount available for prompt cash payment at this facility.

Insurance Median

$51

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: $165 (159%)

Insurance Median: $51 (49%)

Cash: $165 (159% of Medicare)

Ins. Median: $51 (49% 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
Meridian	$8 - $120	8%
Molina	$16 - $120	15%
Humana	$23 - $112	22%
Aetna	$24 - $165	23%
UnitedHealthcare	$24 - $154	23%
Community Partners Health Plan (Cphp)	$48 - $150	46%
Cigna	$50 - $155	48%
Healthlink	$52 - $162	50%
Blue Cross Blue Shield	$54 - $210	52%
Multiplan/Phcs	$60 - $188	58%
Wellcare	$109	105%

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 $165.
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 Carle Eureka 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.