Group therapy session
Facility: Kiowa District Hospital
Billing Code: 90853 (CPT)
- CPT Billing Code: 90853
- Insurance Median: $285
- Cash Discount Price: $240
- vs. Medicare Baseline: 2.75x 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 275% of the Medicare baseline (a markup of 175%). 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% |
| Tricare | $117 | 113% |
| Healthchoice-All Plans | $137 | 132% |
| Health Partners Of Ks-All Plans | $264 | 254% |
| Humana | $271 | 261% |
| Gbs Insurance - All Plans | $282 | 272% |
| Multiplan-All Plans | $282 | 272% |
| Triwest-All Plans | $285 | 275% |
| UnitedHealthcare | $285 - $300 | 275% |
| Aetna | $285 | 275% |
| Medicare (plans) | $285 | 275% |
| Medicaid / KanCare | $300 | 289% |
| Providers Care (Wppa)-All Plans | $450 | 434% |
| Liberty Healthshare-All Plans | $484 | 466% |
Consumer Guidance & Cost Commentary
For the CPT code 90853 representing a group therapy session at Kiowa District Hospital in Kiowa, Kansas, the facility's cash median rate is $240.00, which is lower than the negotiated rates paid by most insurance payers. While the facility's cash price is notably lower than the gross charge of $300.00, patients with high-deductible plans may find that paying the cash rate directly is more cost-effective than relying on insurance, as many commercial payers have negotiated rates ranging from $282.00 to $484.00. This disparity highlights that in-network coverage does not always guarantee the lowest possible price, and patients should verify their specific plan's allowed amount before scheduling to ensure they are not overpaying due to administrative structures that inflate baseline prices.
The facility's negotiated rates average $285.00, which aligns closely with the median paid amount of $284.00 and the median negotiated rate of $285.00 across payers. When compared to the Medicare benchmark of $103.79, the commercial negotiated rates represent a significant markup, illustrating the typical pricing dynamics where commercial rates can average 200% to 300% of the Medicare baseline. To optimize costs, patients are encouraged to inquire about "self-pay" or "prompt-pay" discounts, which can reduce bills by 20% to 50% if paid upfront, bypassing the administrative overhead associated with insurance claims processing. Additionally, since over 80% of hospital bills often contain errors, patients should request an itemized billing audit to identify any unbund