Group therapy session
Facility: Holton Community Hospital
Billing Code: 90853 (CPT)
- CPT Billing Code: 90853
- Insurance Median: $245
- Cash Discount Price: $221
- vs. Medicare Baseline: 2.36x 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 236% of the Medicare baseline (a markup of 136%). 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% |
| Aetna | $156 - $295 | 150% |
| UnitedHealthcare | $156 - $206 | 150% |
| Humana | $158 | 152% |
| Kansas Superior Select - All Plans | $159 | 153% |
| Preferred Health Professionals | $245 | 236% |
| Preferred Health Freedom | $245 | 236% |
| Preferred Health Fn Select - All Other Plans | $245 | 236% |
| Wppa Providers - All Plans | $280 | 270% |
| Medicaid / KanCare | $295 | 284% |
Consumer Guidance & Cost Commentary
For a group therapy session (CPT 90853) at Holton Community Hospital in Holton, Kansas, the cash median price is $221.00, which is lower than the facility's gross charge of $295.00. While several insurance plans, including Aetna and UnitedHealthcare, have negotiated rates ranging from $156 to $295, patients with high-deductible plans may find paying cash upfront more cost-effective if their insurance allowed amount exceeds the cash price. It is important to note that prompt-pay discounts, which can reduce bills by 20% to 50%, are often available for upfront payments and should be requested before scheduling to avoid automatic claims submission that voids these savings.
The facility's cash rate of $221.00 is notably higher than the state of Kansas average for this service, though specific county averages were not provided in the data. Commercial negotiated rates vary significantly by payer, with Medicaid/KanCare and Humana offering the lowest rates at $158, while some plans like Blue Cross Blue Shield and Wppa Providers charge the full gross amount. Under the No Surprises Act, patients are protected from balance billing for out-of-network services at in-network facilities, but they should still verify their specific plan's allowed amount and deductible status before receiving care to ensure they are not liable for unexpected differences between the negotiated rate and their out-of-pocket maximum.