Group therapy session
Facility: Salina Regional Health Center
Billing Code: 90853 (CPT)
- CPT Billing Code: 90853
- Insurance Median: $358
- Cash Discount Price: $279
- vs. Medicare Baseline: 3.45x 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 345% of the Medicare baseline (a markup of 245%). 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 | $31 - $33 | 30% |
| Preferred Phsic | $239 | 230% |
| Preferred Healthcare - All Other Plans | $323 | 311% |
| Providers Care (Wppa)-All Plans | $358 | 345% |
| Aetna | $358 | 345% |
| Multiplan (Mpi)-All Plans | $358 | 345% |
| Cigna | $358 | 345% |
Consumer Guidance & Cost Commentary
For the CPT code 90853 representing a group therapy session at Salina Regional Health Center in Salina, Kansas, the facility's cash median price is $279.00, which is lower than the state average of $358.00. While the facility's negotiated rates with insurance payers average $358.00, this amount is significantly higher than the cash price. For patients with high-deductible plans or those who have already met their out-of-pocket maximum, paying the cash rate of $279.00 directly may result in substantial savings compared to the insurance negotiated rate. It is important to note that the facility offers voluntary non-profit status and is located in an acute care hospital setting, but patients should verify their specific plan details before scheduling to ensure they are utilizing the most cost-effective payment option available.
When reviewing the billing statement for this service, consumers should request an itemized bill rather than accepting a summary invoice, as over 80% of hospital bills contain errors such as unbundled codes or services not rendered. The facility's gross charge for this procedure is $398.00, which serves as the starting point for any potential discounts. If a patient chooses to pay out-of-network or self-pay, they should inquire about prompt-pay discounts, which can reduce the final amount by 20% to 50% if settled within 30 days. Additionally, under the No Surprises Act, patients are protected from balance billing for emergency care and non-emergency services at in-network facilities, ensuring that the final cost aligns with the negotiated or cash rates discussed above.