Group therapy session
Facility: Memorial Hospital
Billing Code: 90853 (CPT)
- CPT Billing Code: 90853
- Insurance Median: $397
- Cash Discount Price: $86
- vs. Medicare Baseline: 3.83x 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 383% of the Medicare baseline (a markup of 283%). 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 |
|---|---|---|
| Tricare | $24 - $393 | 23% |
| Ambetter / Centene | $26 - $433 | 25% |
| Blue Cross Blue Shield | $31 | 30% |
| Humana | $393 | 379% |
| Medicare (plans) | $397 | 383% |
| Coventry - All Other Plans | $708 | 682% |
| Health Partners Of Kansas - All Plans | $747 | 720% |
| Preferred Healthcare-All Plans | $747 | 720% |
| Wppa/Providers Care-All Plans | $1,101 | 1061% |
Consumer Guidance & Cost Commentary
For the CPT code 90853, representing a group therapy session at Memorial Hospital in Abilene, KS, the cash price is $86.00, which matches the facility's median negotiated rate of $708.00 for in-network payers. While the facility's cash rate is significantly lower than the highest negotiated rates found for Humana ($393) and Wppa/Providers Care ($1,101), it is important to note that commercial insurance plans often pay much higher amounts than the cash price due to administrative costs and contract structures. Patients with high-deductible plans may find that paying the $86.00 cash price directly is more cost-effective than relying on insurance, which could result in a higher allowed amount before the patient's deductible is met. Additionally, patients should inquire about "self-pay" or "prompt-pay" discounts, as hospitals often offer further reductions for upfront payments to bypass the lengthy insurance claims process.
This service is provided by a Critical Access Hospital in a rural area, and the facility's pricing is benchmarked against the Medicare rate of $103.79. The cash price of $86.00 is approximately 83% of the Medicare amount, suggesting a competitive rate relative to federal standards. However, the wide variation in negotiated rates across different payers—ranging from $24 for Tricare to $1,101 for Wppa/Providers Care—highlights that insurance coverage can drastically alter out-of-pocket costs. To avoid unexpected balance billing, patients should verify their plan's network status and request an itemized bill if charges seem inconsistent with the negotiated rates. Finally,