Group therapy session
Facility: Wamego Health Center
Billing Code: 90853 (CPT)
- CPT Billing Code: 90853
- Insurance Median: $30
- Cash Discount Price: $126
- vs. Medicare Baseline: 0.29x 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 |
|---|---|---|
| UnitedHealthcare | $25 | 24% |
| Aetna | $26 | 25% |
| Medicaid / KanCare | $26 | 25% |
| Providrs Care | $33 | 32% |
| Blue Cross Blue Shield | $39 - $41 | 38% |
| Tricare | $61 | 59% |
Consumer Guidance & Cost Commentary
For the procedure "Group therapy session" (CPT 90853) at Wamego Health Center in Wamego, KS, the cash median price is $126.00, which is lower than the facility's gross charge of $316.00. While the facility offers a negotiated rate of $30.00 for Medicaid/KanCare plans, commercial payers like UnitedHealthcare and Aetna have negotiated rates ranging from $25.00 to $26.00, which are significantly lower than the cash price. This pricing structure suggests that for patients with high-deductible plans, paying cash upfront might not be the most cost-effective option, as the insurance negotiated rates often exceed the cash price. However, patients should always verify their specific plan's deductible status before scheduling, as paying out-of-pocket could result in a higher out-of-pocket expense if the negotiated rate is higher than what their insurance would cover after deductibles.
To ensure you receive the most accurate billing, it is important to understand that commercial rates are often inflated by administrative costs and contract structures, making them higher than the Medicare benchmark of $103.79 for this service. While the facility is a Voluntary non-profit Critical Access Hospital, the data does not provide a specific comparison to state or county averages for this code. Patients should request a full itemized bill before paying to avoid balance billing or errors, as summary bills can obscure individual charges. If you are self-pay, ask the billing department about prompt-pay discounts, which can reduce the total cost by 20% to 50% if paid in full within 30 days, bypassing the