Group therapy session
Facility: Overland Park Reg Med Ctr
Billing Code: 90853 (CPT)
- CPT Billing Code: 90853
- Insurance Median: $27
- Cash Discount Price: $71
- vs. Medicare Baseline: 0.26x 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 | $9 - $31 | 9% |
| Ambetter / Centene | $13 | 13% |
| Nhc Advantage | $14 | 13% |
| Oscar | $14 | 13% |
| Healthyblue | $14 | 13% |
| Wppa Providrs Care Network | $14 | 13% |
| United | $18 - $79 | 17% |
| Cigna | $18 - $26 | 17% |
| Aetna | $21 - $36 | 20% |
| Universal Healthcare | $25 | 24% |
| Coventry | $29 | 28% |
| Coventry Kc Mo | $29 | 28% |
| College Park Family Care Center | $31 - $225 | 30% |
| Oha Network | $36 | 35% |
| Multiplan | $38 - $57 | 37% |
| Corvel Corporation | $46 | 44% |
| Triwest Health Alliance | $53 | 51% |
| Focus Healthcare Mgmt, Inc | $53 | 51% |
| Cco, Inc. | $53 | 51% |
| Home State Health Plan | $83 | 80% |
Consumer Guidance & Cost Commentary
For this group therapy session (CPT 90853) at Overland Park Reg Med Ctr, the cash price is $71.00, which matches the facility's cash median. This rate is 30% higher than the Medicare benchmark of $103.79, indicating a markup relative to the federal cost baseline. While the facility offers a negotiated rate of $27.00 for in-network patients, this amount is significantly lower than the cash price, suggesting that commercial insurance contracts provide a substantial discount for those with active coverage. However, patients with high-deductible plans should be aware that if their insurance negotiated rate exceeds the cash price, paying out-of-pocket could result in lower immediate costs, though they would be responsible for the full amount without insurance coverage.
The facility's pricing structure reflects standard commercial dynamics where negotiated rates serve as a ceiling to protect in-network members, often incorporating administrative costs that inflate the baseline price. With 20 different payers participating, including Blue Cross Blue Shield and United, the allowed amounts vary widely, ranging from $9 to $225 depending on the specific plan. To minimize costs, patients should verify their specific plan's allowed amount before scheduling and ask the billing department about "self-pay" or "prompt-pay" discounts, which can reduce the final bill by 20% to 50% if paid upfront. Additionally, since over 80% of hospital bills contain errors, patients should request a detailed, itemized statement to ensure no charges for services not rendered or unbundled codes are included before finalizing payment.