Group therapy session
Facility: Pratt Regional Medical Center
Billing Code: 90853 (CPT)
- CPT Billing Code: 90853
- Insurance Median: $78
- Cash Discount Price: $55
- vs. Medicare Baseline: 0.75x 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 |
|---|---|---|
| Christian Health Aid | $59 | 57% |
| UnitedHealthcare | $65 - $91 | 63% |
| Health Partners Of Kansas | $66 | 64% |
| Aetna | $70 | 67% |
| Choicecare | $78 | 75% |
| Celtic Insurance Company | $83 | 80% |
| Healthy Blue | $85 | 82% |
Consumer Guidance & Cost Commentary
For this procedure, the cash price of $55.00 is lower than the facility's negotiated rate of $78.00, which aligns with the state average for Kansas. While commercial payers like UnitedHealthcare and Health Partners Of Kansas have negotiated rates ranging from $65 to $91, patients with high-deductible plans may find paying the cash price directly more cost-effective, as the cash rate is significantly below the insurer's allowed amount. It is important to note that while the facility is in-network for these payers, the cash price remains the most transparent baseline for comparison.
To ensure you receive the best possible rate, you should ask the billing department about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront fee reductions can lower the final cost further. If you are ever billed for services rendered by out-of-network providers at this facility, the No Surprises Act protects you from balance billing for emergency and non-emergency care. Additionally, if you receive a summary bill, request a full itemized statement to verify that all charges are accurate and that no unbundled codes or services not rendered have been included.