Group therapy session
Facility: University Of Kansas Health System - St Francis Campus
Billing Code: 90853 (CPT)
- CPT Billing Code: 90853
- Insurance Median: $110
- Cash Discount Price: $81
- vs. Medicare Baseline: 1.06x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Blue Cross Blue Shield | $110 | 106% |
| Aetna | $110 | 106% |
| Hooray Health [8000] | $110 | 106% |
| Black Lung [6055] | $110 | 106% |
| Web Tpa [2115] | $110 | 106% |
| Healthcare Highways [2210] | $110 | 106% |
| Lucent Health [6000] | $110 | 106% |
| Oncology Patient Assistance Programs [2295] | $110 | 106% |
| 1199 Seiu Benefit Fund [3505] | $181 | 174% |
| Enablecomp [1350] | $188 | 181% |
| Worker'S Comp [2125] | $188 | 181% |
| Ks Disability Determination [6090] | $269 | 259% |
Consumer Guidance & Cost Commentary
For the CPT code 90853, representing a group therapy session at the University Of Kansas Health System - St Francis Campus in Topeka, the facility's cash price is $81.00, which is significantly lower than the negotiated rates of $110.00 paid by most major payers listed, such as Blue Cross Blue Shield and Aetna. While the facility's gross charge is $269.00, the median amount paid by insurers is also $269.00, indicating that for many patients, the insurance negotiated rate exceeds the cash price. This scenario highlights a common billing dynamic where paying out-of-pocket directly can result in substantial savings compared to using insurance, particularly for those with high-deductible plans or those who have already met their annual out-of-pocket maximum. Patients are encouraged to explicitly ask the hospital about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront fee reductions can further lower the cost below the standard cash rate of $81.00.
The pricing for this service is benchmarked against the federal Medicare rate of $103.79, which serves as an objective baseline for evaluating the facility's markup. The facility's cash rate of $81.00 is below the Medicare benchmark, suggesting a competitive pricing structure relative to the government's cost-based standard. However, the negotiated rates of $110.00 paid by commercial insurers are higher than both the cash price and the Medicare rate, reflecting the administrative costs and contract dynamics inherent in the insurance billing cycle. Given that over 80% of hospital bills often contain errors, patients should request a detailed, itemized