Group therapy session
Facility: Trego County Lemke Memorial Hospital
Billing Code: 90853 (CPT)
- CPT Billing Code: 90853
- Insurance Median: $72
- Cash Discount Price: $343
- vs. Medicare Baseline: 0.69x 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 |
|---|---|---|
| Humana | $35 - $360 | 34% |
| Tricare | $38 - $389 | 37% |
| Blue Cross Blue Shield | $41 | 40% |
| Medicaid / KanCare | $45 - $735 | 43% |
| UnitedHealthcare | $45 - $735 | 43% |
| Aetna | $45 - $662 | 43% |
| Ambetter / Centene | $49 - $501 | 47% |
| Health Partners - All Plans | $68 - $698 | 66% |
| Healthy Blue Mcaid - All Plans | $72 - $735 | 69% |
Consumer Guidance & Cost Commentary
For the CPT code 90853, representing a group therapy session at Trego County Lemke Memorial Hospital, the facility's cash price of $343.00 is notably lower than the median negotiated rate of $375.00 paid by commercial insurers. While the hospital is a Critical Access Hospital in Wakeeney, Kansas, with a government-local ownership structure, patients should be aware that commercial payers like Medicaid/KanCare and UnitedHealthcare have negotiated rates ranging from $45 to $735, significantly higher than the cash price. This disparity highlights a common billing dynamic where cash-pay options can be more cost-effective than insurance claims, particularly for patients with high-deductible plans who may face out-of-pocket costs exceeding the cash rate.
To maximize savings, consumers should verify the facility's "self-pay" or "prompt-pay" discounts before scheduling, as these upfront payment incentives can bypass the administrative overhead and multi-layered contract structures that inflate commercial rates. Although the facility does not have a published rating, the Medicare benchmark for this service is $103.79, which serves as a critical baseline for evaluating the true cost of care. By comparing the facility's rates directly to this federal standard rather than the inflated chargemaster list, patients can better understand the markup involved and avoid unexpected balance billing, especially given that federal protections now limit surprise charges for out-of-network services at in-network facilities.