Group therapy session
Facility: Phillips County Hospital
Billing Code: 90853 (CPT)
- CPT Billing Code: 90853
- Insurance Median: $295
- Cash Discount Price: $251
- vs. Medicare Baseline: 2.84x 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 284% of the Medicare baseline (a markup of 184%). 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 | $30 - $239 | 29% |
| UnitedHealthcare | $295 | 284% |
| Health Partners-All Plans | $295 | 284% |
| Medicaid / KanCare | $295 | 284% |
Consumer Guidance & Cost Commentary
For this procedure, the cash price of $251.00 is notably lower than the median negotiated rate of $295.00, which aligns with the typical range where commercial contracts average 200% to 300% of the Medicare benchmark of $103.79. While the facility's negotiated rate of $295.00 matches the highest range observed among payers like Blue Cross Blue Shield and UnitedHealthcare, patients with high-deductible plans may find the cash price more advantageous if their insurance allowed amount exceeds this figure. It is important to note that the median paid amount of $496.00 suggests that many patients are being billed significantly higher than the negotiated rate, likely due to balance billing or administrative markups that inflate the baseline price by 20% to 40%.
To secure the most favorable rate, patients should explicitly request a "self-pay" or "prompt-pay" discount before scheduling, as hospitals often offer fee reductions of 20% to 50% for upfront payment to bypass costly claims processing. Since the No Surprises Act prohibits balance billing for emergency care and non-emergency services at in-network facilities, patients should verify their network status and ensure no out-of-network ancillary services are included in the final invoice. If a bill is received, requesting a full itemized audit is critical, as over 80% of hospital bills contain errors such as double-billing or unbundled codes that can be corrected to reduce medical debt.