Group therapy session
Facility: Mcpherson Hospital
Billing Code: 90853 (CPT)
- CPT Billing Code: 90853
- Insurance Median: $321
- Cash Discount Price: $311
- vs. Medicare Baseline: 3.09x 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.
Elevated Commercial Rate Alert (Value-Gap)
The negotiated rate at this facility is 309% of the Medicare baseline (a markup of 209%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
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 |
|---|---|---|
| Tricare | $82 | 79% |
| Healthy Blue Mcr Adv | $93 | 90% |
| Blue Cross Blue Shield | $93 | 90% |
| Va Ccn - All Plans | $93 | 90% |
| UnitedHealthcare | $93 - $420 | 90% |
| Humana | $93 | 90% |
| Wellcare Mcr Adv - All Plans | $93 | 90% |
| Ambetter / Centene | $107 | 103% |
| Wppa - All Plans | $294 | 283% |
| Central Plains - All Plans | $315 | 303% |
| Medical Associates - All Plans | $315 | 303% |
| Christian Health Aid - All Plans | $336 | 324% |
| Aetna | $346 - $420 | 333% |
| Multiplan - All Plans | $378 | 364% |
| Health Partners - All Plans | $399 | 384% |
| Cigna | $399 | 384% |
| First Health - All Plans | $399 | 384% |
| Medicaid / KanCare | $420 | 405% |
| Health Blue Mcaid - All Other Plans | $428 | 412% |
Consumer Guidance & Cost Commentary
For CPT code 90853, a group therapy session at McPherson Hospital in Mcpherson, KS, the facility's cash median rate is $311.00, which is lower than the state average of $341.00. While many insurance plans negotiate rates ranging from $82 to $420, patients with high-deductible plans may find paying the cash price directly more cost-effective, as some negotiated amounts exceed the cash rate. To secure the best possible price, it is advisable to contact the hospital directly to inquire about self-pay or prompt-pay discounts, which can further reduce the final bill before any insurance processing occurs.
This service is benchmarked against Medicare, which sets a fixed reimbursement rate of $103.79 for this procedure. The facility's cash rate of $311.00 represents a significant markup over the Medicare baseline, illustrating how commercial pricing often differs from federal standards. If you have insurance, be aware that while in-network contracts cap charges, the allowed amount for some payers can still be higher than the cash price. Additionally, if you receive care from out-of-network providers, the No Surprises Act protects you from balance billing for emergency services and non-emergency care at in-network facilities, so you should never feel pressured to pay unexpected bills immediately without first requesting an audit or dispute.