Group therapy session
Facility: Hospital District #6 Patterson Health Center
Billing Code: 90853 (CPT)
- CPT Billing Code: 90853
- Insurance Median: $275
- Cash Discount Price: $331
- vs. Medicare Baseline: 2.65x 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 265% of the Medicare baseline (a markup of 165%). 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 | $28 - $29 | 27% |
| UnitedHealthcare | $200 - $628 | 193% |
| Providers Care (Wppa)-All Plans | $350 - $1,099 | 337% |
Consumer Guidance & Cost Commentary
For the CPT code 90853, representing a group therapy session, the facility's cash median price is $331.00, which is lower than the gross charge of $414.00. While the facility is a Critical Access Hospital in Anthony, KS, serving the 67003 zip code, the data does not provide specific state or county average figures for comparison. However, it is important to note that commercial negotiated rates can sometimes exceed cash prices; for instance, UnitedHealthcare's negotiated range spans from $200 to $628, meaning patients with high-deductible plans might find paying the cash median of $331.00 directly more cost-effective than relying on insurance reimbursement, especially if their plan's allowed amount is high.
Patients should be aware that while the No Surprises Act protects against balance billing for emergency care and non-emergency services from out-of-network providers at in-network facilities, unexpected charges can still occur if ancillary services like labs or emergency physicians are out-of-network. To avoid these surprises, consumers should request a full itemized bill before paying, as summary invoices often hide unbundled codes or services not rendered. Additionally, since the facility is a Government-owned Hospital District, patients should explicitly ask about "self-pay" or "prompt-pay" discounts before scheduling, as paying upfront can often reduce the total cost by bypassing administrative fees and insurance processing delays.