Group therapy session
Facility: Menorah Medical Center
Billing Code: 90853 (CPT)
- CPT Billing Code: 90853
- Insurance Median: $83
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 0.80x 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 |
|---|---|---|
| United | $79 | 76% |
| Home State Health Plan | $83 | 80% |
| College Park Family Care Center | $225 | 217% |
Consumer Guidance & Cost Commentary
For the CPT code 90853 (Group therapy session) at Menorah Medical Center in Overland Park, KS, the facility's negotiated rates with major payers like United and Home State Health Plan range from $79 to $83. These amounts are significantly higher than the cash price, which is not listed for this service. While commercial insurance contracts often include administrative overhead that inflates the baseline price by 20% to 40%, patients with high-deductible plans may find it more cost-effective to pay the cash price directly, provided the facility offers a self-pay or prompt-pay discount. It is crucial to verify these discounts with the hospital before scheduling, as waiting until after receiving a large post-insurance bill often results in missing out on available fee reductions.
The facility's pricing is also evaluated against the Medicare benchmark, which serves as a scientifically validated cost baseline for healthcare delivery. For this specific procedure, the Medicare amount is $103.79, and the facility's negotiated rates are approximately 80% of this federal rate. This indicates that the facility is pricing below the standard commercial markup often seen in the industry, where rates can average 200% to 300% of the Medicare amount. However, because the data does not provide a specific county or state average for this code, direct comparisons to regional pricing norms cannot be made. Patients should always request an itemized billing audit to ensure no errors, such as unbundled codes or services not rendered, are included in the final invoice, as over 80% of hospital bills contain some form of billing error.