Group therapy session
Facility: Cheyenne County Hospital
Billing Code: 90853 (CPT)
- CPT Billing Code: 90853
- Insurance Median: $864
- Cash Discount Price: $982
- vs. Medicare Baseline: 8.32x 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 832% of the Medicare baseline (a markup of 732%). 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 |
|---|---|---|
| Blue Cross Blue Shield | $29 | 28% |
| First Health - All Plans | $228 - $840 | 220% |
| UnitedHealthcare | $234 - $864 | 225% |
| Aetna | $234 - $1,140 | 225% |
| Healthy Blue Mcr Adv | $234 - $864 | 225% |
| Tricare | $234 - $864 | 225% |
| Choice Care - All Plans | $236 - $873 | 227% |
| Firstguard - All Plans | $260 - $960 | 251% |
| Wppa - All Plans | $292 - $1,080 | 281% |
| Cpm - All Plans | $309 - $1,140 | 298% |
| Preferred Hc - All Plans | $309 - $1,140 | 298% |
| Midlands Choice - All Plans | $315 - $1,164 | 303% |
| Unicare - All Plans | $318 - $1,176 | 306% |
| Health Partners - All Plans | $318 - $1,176 | 306% |
| Ppo Next - All Plans | $318 - $1,176 | 306% |
| Integrated Hp - All Plans | $318 - $1,176 | 306% |
| Childrens Mercy - All Plans | $325 - $1,200 | 313% |
| Healthwave Mcaid - All Plans | $325 - $1,200 | 313% |
| Healthy Blue Mcaid - All Other Plans | $325 - $1,200 | 313% |
| Providers Care-All Plans | $488 - $1,800 | 470% |
Consumer Guidance & Cost Commentary
For CPT code 90853, a group therapy session at Cheyenne County Hospital in St. Francis, KS, the facility's cash median rate is $982.00, while the median negotiated rate paid by insurance plans is $864.00. This cash price is notably higher than the facility's own negotiated rates, which can be advantageous for patients with high-deductible plans or those without insurance, as paying out-of-pocket may avoid the administrative overhead embedded in commercial contracts. However, patients should verify their specific plan's allowed amount, as some insurers may negotiate rates lower than the cash price, potentially resulting in higher out-of-pocket costs if the patient's deductible has not yet been met.
The facility, a voluntary non-profit Critical Access Hospital, operates under a chargemaster gross of $1,155.00, which serves as the baseline for potential balance billing if a patient is out-of-network. Under the No Surprises Act, patients receiving care at this in-network facility are protected from balance billing for out-of-network ancillary services, though they should still review their itemized bill to ensure no unbundled charges or services not rendered are included. To minimize costs, patients are encouraged to contact the hospital directly to inquire about self-pay or prompt-pay discounts, which can reduce the final bill by 20% to 50% if paid in full upfront, bypassing the standard insurance claims cycle.