Group therapy session
Facility: Fredonia Regional Hospital
Billing Code: 90853 (CPT)
- CPT Billing Code: 90853
- Insurance Median: $271
- Cash Discount Price: $301
- vs. Medicare Baseline: 2.61x 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 261% of the Medicare baseline (a markup of 161%). 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 - $149 | 29% |
| Veterans Programs - All Plans | $153 | 147% |
| Aetna | $153 - $271 | 147% |
| Meritain-All Plans | $271 | 261% |
| Cigna | $271 | 261% |
| Reserve National-All Plans | $271 | 261% |
| UnitedHealthcare | $271 | 261% |
Consumer Guidance & Cost Commentary
For this procedure, the cash price at Fredonia Regional Hospital is $301.00, which matches the cash median for the region. While the facility is a Critical Access Hospital in Kansas, the data does not provide specific county or state average comparisons to contextualize this rate. It is important to note that for patients with high-deductible plans, paying the cash price directly can sometimes be more cost-effective than using insurance, as the negotiated rate paid by insurers for this service is $271.00. However, since the cash price is identical to the negotiated rate in this instance, there is no immediate financial advantage to paying out-of-pocket unless the patient's insurance plan applies a higher allowed amount or has a high deductible that delays coverage.
Patients should verify if the hospital offers "self-pay" or "prompt-pay" discounts before scheduling, as these upfront payment incentives can reduce the final bill by 20% to 50%. Additionally, while the Medicare benchmark for this code is $103.79, commercial rates often exceed this baseline due to administrative costs and contract structures; the median negotiated rate here is $271.00, which is approximately 2.6 times the Medicare amount. To ensure you are receiving the most accurate pricing, always request an itemized bill before paying, as summary bills may obscure individual charges or errors. If you receive a bill that seems incorrect, dispute it in writing with the billing supervisor rather than accepting verbal assurances, and check your insurance status to confirm whether you have met your deductible before proceeding with treatment.