Group therapy session
Facility: St Luke Hospital & Living Center
Billing Code: 90853 (CPT)
- CPT Billing Code: 90853
- Insurance Median: $217
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 2.09x 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 209% of the Medicare baseline (a markup of 109%). 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 |
|---|---|---|
| Va Ccn | $217 | 209% |
| Bluestem Pace | $217 | 209% |
| UnitedHealthcare | $217 | 209% |
| Kansas Department Of Health And Environment | $217 | 209% |
| Blue Cross Blue Shield | $217 | 209% |
| Humana | $217 | 209% |
| Ambetter / Centene | $219 | 211% |
Consumer Guidance & Cost Commentary
For the CPT code 90853, representing a group therapy session at St Luke Hospital & Living Center in Marion, Kansas, the facility's gross charge is $425.00. While the facility is a Critical Access Hospital owned by the Government - Hospital District or Authority, the negotiated rates across seven payers, including UnitedHealthcare and Humana, are consistently set at $217.00. This negotiated amount is significantly higher than the Medicare benchmark of $103.79, reflecting the administrative costs and contract structures inherent in commercial insurance billing. For patients with high-deductible plans, it is important to note that the cash price is not listed in this report; however, if the cash price were lower than the $217.00 allowed amount, paying out-of-pocket could result in lower total costs before the deductible is met.
The facility's pricing structure suggests that the negotiated rate of $217.00 serves as a ceiling for in-network members, protecting them from the full $425.00 chargemaster list price. To ensure you are receiving the best possible rate, it is recommended to explicitly ask the hospital about "self-pay" or "prompt-pay" discounts before scheduling your visit, as these upfront payment incentives can reduce the final bill by 20% to 50%. Additionally, since over 80% of hospital bills often contain errors, patients should request a detailed, itemized statement rather than accepting a summary bill, and verify that no balance billing is occurring by confirming the facility's in-network status and understanding the specific terms of your insurance plan.