Group therapy session
Facility: Hiawatha Community Hospital
Billing Code: 90853 (CPT)
- CPT Billing Code: 90853
- Insurance Median: $170
- Cash Discount Price: $218
- vs. Medicare Baseline: 1.64x 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 |
|---|---|---|
| Blue Cross Blue Shield | $28 - $30 | 27% |
| UnitedHealthcare | $81 - $187 | 78% |
| Aetna | $81 - $176 | 78% |
| Humana | $81 | 78% |
| Ambetter / Centene | $97 | 93% |
| Oscar - All Plans | $164 | 158% |
| Centrus Health Direct - All Plans | $164 | 158% |
| Preferred Hlth - All Plans | $196 | 189% |
| Wppa Providrs Care - All Plans | $207 | 199% |
| Cigna | $207 | 199% |
| Midlands Choice - All Plans | $211 | 203% |
| Multiplan - All Plans | $211 | 203% |
| Healthy Blue Mcaid - All Plans | $218 | 210% |
Consumer Guidance & Cost Commentary
For the CPT code 90853, representing a group therapy session at Hiawatha Community Hospital in Hiawatha, KS, the cash price is $218.00, which matches the facility's gross charge. This cash rate is significantly higher than the state average of $103.79, reflecting the facility's pricing structure for Critical Access Hospitals. While commercial insurance plans like Blue Cross Blue Shield and UnitedHealthcare negotiate rates ranging from $28 to $218, these negotiated amounts often exceed the cash price due to administrative overhead and contract dynamics. Patients with high-deductible plans may find it financially advantageous to pay the $218.00 cash price directly, as this avoids the potential for higher negotiated rates and subsequent balance billing if their insurance does not cover the full amount.
To optimize costs, patients should proactively inquire about "self-pay" or "prompt-pay" discounts before scheduling, as these programs can offer immediate fee reductions by bypassing insurance billing cycles. It is important to note that the facility's median negotiated rate of $170.00 is lower than the cash price, but this does not guarantee the lowest possible cost for every patient, as some commercial payers have negotiated rates as high as $218.00. Additionally, the facility's rating of 3 and its voluntary non-profit status provide context for its pricing model, but the most reliable method for reducing out-of-pocket expenses remains comparing the cash price against the specific allowed amounts of your insurance plan. Always request an itemized bill to verify charges and ensure no errors exist before finalizing payment.