Group therapy session
Facility: Cloud County Health Center
Billing Code: 90853 (CPT)
- CPT Billing Code: 90853
- Insurance Median: $55
- Cash Discount Price: $56
- vs. Medicare Baseline: 0.53x 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 |
|---|---|---|
| Pponext-All Plans | $24 - $86 | 23% |
| Mpi-All Plans | $34 | 33% |
Consumer Guidance & Cost Commentary
For this group therapy session at Cloud County Health Center in Concordia, KS, the facility's cash price of $56.00 is notably lower than the state average, which sits at $76.00. While the facility's negotiated rate for in-network payers is $55.00, this amount is still higher than the cash price, illustrating a common billing dynamic where paying out-of-pocket can be more cost-effective for patients with high-deductible plans or those without insurance. The facility's gross charge of $80.00 represents the maximum billed amount before any discounts are applied, and patients should verify if "self-pay" or "prompt-pay" discounts are available before scheduling to potentially reduce this cost further.
When comparing this service to federal benchmarks, the Medicare allowed amount of $103.79 serves as a reliable baseline for understanding the true cost of care, as it reflects the facility's actual operating expenses rather than inflated list prices. The commercial negotiated rate of $55.00 is approximately 53% of the Medicare amount, indicating a pricing structure that is significantly below the typical commercial markup seen in many facilities. To ensure you are receiving the best possible rate, it is advisable to request an itemized bill to confirm that no unbundled codes or services not rendered are included, and to explicitly ask the billing department about any prompt-pay incentives that could lower your final out-of-pocket expense.