Group therapy session
Facility: Centura St. Catherine-Dodge City
Billing Code: 90853 (CPT)
- CPT Billing Code: 90853
- Insurance Median: $24
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 0.23x 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 |
|---|---|---|
| Kaiser | $24 | 23% |
| Blue Cross Blue Shield | $24 - $35 | 23% |
| Kansas Health | $24 | 23% |
| Humana | $24 | 23% |
| Cigna | $24 | 23% |
| Aetna | $24 | 23% |
| Medicare (plans) | $24 | 23% |
Consumer Guidance & Cost Commentary
For this CPT code representing a group therapy session at Centura St. Catherine-Dodge City, the negotiated rates across seven payers range from $24 to $35, with a median negotiated amount of $24.00. This facility is located in Dodge City, Kansas, and operates as an acute care hospital. While specific cash and median paid values are not available in the current dataset, it is important to note that cash-pay options can sometimes be more affordable for patients with high-deductible plans if the insurance negotiated rate exceeds the cash price. Patients should always verify self-pay or prompt-pay discounts directly with the hospital before scheduling, as these upfront payment incentives can significantly reduce out-of-pocket costs by bypassing administrative fees and claims processing delays.
The Medicare benchmark for this service is $103.79, which serves as a critical baseline for evaluating pricing fairness. Commercial negotiated rates generally average between 200% and 300% of Medicare rates, though fair pricing is typically defined as 120% to 150% of the Medicare amount. In this instance, the $24.00 median negotiated rate is substantially lower than the Medicare benchmark, indicating a highly competitive pricing structure compared to federal standards. Consumers should be aware that balance billing is largely prohibited for emergency care and non-emergency services at in-network facilities under the No Surprises Act, but if unexpected charges arise, patients should dispute the bill in writing rather than accepting summary invoices that may hide unbundled codes or services not rendered.