Group therapy session
Facility: Clay County Medical Center
Billing Code: 90853 (CPT)
- CPT Billing Code: 90853
- Insurance Median: $400
- Cash Discount Price: $425
- vs. Medicare Baseline: 3.85x 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 385% of the Medicare baseline (a markup of 285%). 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 |
|---|---|---|
| Wppa/Providrs Care- All Plans | $395 | 381% |
| Aetna | $395 | 381% |
| Multiplan- All Plans | $404 | 389% |
| Health Partners - All Plans | $404 | 389% |
Consumer Guidance & Cost Commentary
For the CPT code 90853, representing a group therapy session at Clay County Medical Center in Clay Center, KS, the facility's cash median price is $425.00, which matches the gross charge listed. This cash rate is notably higher than the state average of $400.00, though it aligns closely with the county average of $400.00. While commercial payers like Aetna and Wppa/Providrs Care have negotiated rates of $395.00, these amounts may not represent the lowest possible cost for patients with high-deductible plans. In such cases, paying the cash price of $425.00 upfront can sometimes be more economical than the insurance negotiated rate, as the patient would avoid any potential out-of-pocket costs associated with deductibles or copays if the insurer's allowed amount exceeds the cash price.
To maximize savings, patients should proactively contact the hospital to inquire about "self-pay" or "prompt-pay" discounts, which can reduce the bill by 20% to 50% when paid in full before or shortly after the service. It is important to verify that any payment plan or discount does not trigger automatic claims submission to an insurance carrier, which could void the cash agreement and lead to balance billing. Additionally, while the facility is a Critical Access Hospital with a government-local ownership structure, patients should request a detailed, itemized billing audit before finalizing payment, as over 80% of hospital bills contain errors such as unbundled codes or services not rendered. Comparing the facility's pricing against the Medicare benchmark of $103.79 reveals a