CMS Price Transparency Data

Group therapy session

Facility: St Joseph's Hospital

Billing Code: 90853 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90853
Insurance Median: $137
Cash Discount Price: $116
vs. Medicare Baseline: 1.32x Medicare

The contracted insurance negotiated median rate for a Group therapy session at St Joseph's Hospital is $137. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $116. Compared to the federal Medicare reimbursement reference rate of $103.79, this hospital’s rate is 1.32x the Medicare baseline. Located in 12866 Troxler Avenue, Highland, IL.

Cash / Self-Pay

$116

Average discount available for prompt cash payment at this facility.

Insurance Median

$137

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$103.79

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $103.79 (100%)

Cash / Self-Pay: $116 (112%)

Insurance Median: $137 (132%)

Cash: $116 (112% of Medicare)

Ins. Median: $137 (132% of 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.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
UnitedHealthcare	$32 - $161	31%
Humana	$32	31%
Aetna	$32 - $113	31%
Clear Spring Health of Illinois	$32	31%
Sae Hospice	$32	31%
Molina Healthcare	$32 - $161	31%
Blue Cross Blue Shield	$32	31%
Amish Community	$45	43%
Naphcare	$68	66%
Celtic Insurance Company	$71	68%
Hopetrust	$80	77%
Claim Doc	$80	77%
Wellfirst	$103	99%
Cigna	$108	104%
First Health	$119	115%
Healthlink	$137	132%
Multiplan/Phcs	$137	132%
Provider Network of America	$145	140%
Healthcare Finest Network (Hfn)	$145	140%
Current Health Solutions	$161	155%
Interplan	$161	155%
Mental Health Network	$161	155%
Illinois Breast and Cervical Cancer Program	$161	155%
Consociate Group	$161	155%
Healthscope	$161	155%
Qtc Medical Group of Illinois	$161	155%
Health Alliance Medical Plans	$161	155%
Meridian Health Plan	$498	480%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $116.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 90853.

Insurance In-Network Protection Plan

Contact your insurance company to confirm St Joseph's Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 90853.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.