Group therapy session
Facility: Girard Medical Center
Billing Code: 90853 (CPT)
- CPT Billing Code: 90853
- Insurance Median: $74
- Cash Discount Price: $127
- vs. Medicare Baseline: 0.71x 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 |
|---|---|---|
| Blue Cross Blue Shield | $30 - $74 | 29% |
| Aetna | $74 - $369 | 71% |
| Kansas Superior Select-All Plans | $74 | 71% |
| Humana | $74 | 71% |
| UnitedHealthcare | $74 | 71% |
| Ambetter / Centene | $74 | 71% |
| Medicare (plans) | $74 | 71% |
| Multiplan-All Plans | $195 | 188% |
Consumer Guidance & Cost Commentary
For this CPT code representing a group therapy session at Girard Medical Center in Girard, Kansas, the facility's cash median price is $127.00, while the negotiated rate paid by most major insurers, including Aetna, Humana, and UnitedHealthcare, is $74.00. This indicates that for patients with high-deductible plans or those paying out-of-pocket, the cash price may actually be more expensive than the amount their insurance would allow. It is important to note that while the facility is a Critical Access Hospital owned by a government district, the negotiated rates for in-network plans are significantly lower than the cash price, a common dynamic where administrative costs and contract structures inflate the billed amount for insured patients.
When evaluating the cost of this service, it is crucial to compare rates against the Medicare benchmark rather than the hospital's gross charge. The Medicare amount for this procedure is $103.79, which serves as a scientifically validated baseline for the true cost of delivery. The facility's negotiated rate of $74.00 is 70% of the Medicare rate, suggesting a pricing structure that is below the federal benchmark. Patients should be aware that balance billing is generally prohibited for out-of-network services at in-network facilities under the No Surprises Act, but they must still verify their specific plan details. Additionally, since the cash price exceeds the negotiated rate, patients should not assume paying cash will save money; instead, they should confirm their deductible status and ask the billing department about any prompt-pay discounts before scheduling to ensure they are not inadvertently paying more than their insurance would cover.