Group therapy session
Facility: Mitchell County Hospital Health Systems
Billing Code: 90853 (CPT)
- CPT Billing Code: 90853
- Insurance Median: $287
- Cash Discount Price: $279
- vs. Medicare Baseline: 2.77x 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 277% of the Medicare baseline (a markup of 177%). 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 | 29% |
| UnitedHealthcare | $104 - $310 | 100% |
| Triwest Well Mark All Plans | $264 | 254% |
| Pref Hlth Care Sytms Comm - All Plans | $279 | 269% |
| First Health-All Plans | $279 | 269% |
| Aetna | $279 | 269% |
| Auxiant-All Plans | $294 | 283% |
| Phc Leased Ntwrk Access - All Plans | $294 | 283% |
| Multiplan Ppo - All Plans | $294 | 283% |
| Cigna | $307 | 296% |
| Health Partners Ks-All Plans | $307 | 296% |
Consumer Guidance & Cost Commentary
For the CPT code 90853 (Group therapy session) at Mitchell County Hospital Health Systems in Beloit, KS, the cash median price is $279.00, which is lower than the facility's negotiated rates ranging from $264.00 to $310.00 across various payers. While the facility is a Critical Access Hospital with government-local ownership, patients should be aware that cash payments can sometimes be more cost-effective than using insurance, particularly if your plan has a high deductible or if the insurer's negotiated rate exceeds the cash price. To maximize savings, it is recommended to explicitly request "self-pay" or "prompt-pay" discounts before scheduling, as these upfront fee reductions can bypass administrative costs and provide immediate liquidity benefits to the patient.
When evaluating the cost of this service, it is important to compare the facility's pricing against objective benchmarks rather than the hospital's inflated chargemaster list. The Medicare amount for this procedure is $103.79, which serves as a scientifically validated baseline for the true cost of delivery; commercial negotiated rates often exceed this by significant margins due to administrative overhead and contract dynamics. Although specific county or state average data was not provided in the source information, patients are advised to verify their specific plan's allowed amounts before treatment to avoid unexpected balance billing, especially if services are rendered out-of-network or if ancillary services trigger separate billing structures.