Group therapy session
Facility: St. Catherine Hospital - Garden City
Billing Code: 90853 (CPT)
- CPT Billing Code: 90853
- Insurance Median: $118
- Cash Discount Price: $186
- vs. Medicare Baseline: 1.14x 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 |
|---|---|---|
| Aetna | $23 - $256 | 22% |
| Cigna | $23 - $279 | 22% |
| Humana | $23 - $24 | 22% |
| Medicare (plans) | $23 - $24 | 22% |
| Kaiser | $23 - $128 | 22% |
| UnitedHealthcare | $23 - $270 | 22% |
| Blue Cross Blue Shield | $23 - $343 | 22% |
| Kansas Health | $23 | 22% |
| Innovage | $24 | 23% |
| Devoted Health | $24 | 23% |
| Denver Health | $110 | 106% |
| Direct To Employer | $126 - $269 | 121% |
| United Colorado Doctor'S Plan | $174 | 168% |
| Peak Health | $181 - $219 | 174% |
| Centura Employee Plan | $232 | 224% |
| Multiplan | $325 - $395 | 313% |
Consumer Guidance & Cost Commentary
For this procedure, the cash price of $186.00 is significantly lower than the gross charge of $465.00, offering a potential savings of $279.00 for patients paying out-of-pocket. While the facility's cash rate is notably higher than the state average of $118.00, it remains below the gross charges and comparable to the median negotiated rate of $118.00 found across payers. Patients with high-deductible plans may find the cash price advantageous if their insurance negotiated rates exceed this amount, though they should verify their specific plan's allowed amounts before deciding. It is also important to note that the facility offers a prompt-pay discount for upfront payments, which can further reduce the final bill, and patients should explicitly request self-pay classification prior to scheduling to avoid automatic insurance submission.
The Medicare benchmark for this service is $103.79, which serves as a baseline for evaluating the facility's pricing markup. The cash price of $186.00 represents approximately 179% of the Medicare rate, which falls within the typical range of fair pricing (120% to 150%) but slightly exceeds it. Commercial negotiated rates vary widely among payers, ranging from $23 to $395, with some integrated systems like Kaiser listing internal rates that differ from typical negotiated fees. To ensure transparency, patients should request an itemized bill to review specific CPT codes and avoid summary bills that may obscure individual charges. If any balance billing occurs, patients have the right to dispute the bill under the No Surprises Act, particularly if care was received from out-of-network providers at an in