CMS Price Transparency Data

Group therapy session

Facility: Loma Linda University Children's Hospital

Billing Code: 90853 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90853
Insurance Median: $176
Cash Discount Price: $181
vs. Medicare Baseline: 1.70x Medicare

The contracted insurance negotiated median rate for a Group therapy session at Loma Linda University Children's Hospital is $176. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $181. Compared to the federal Medicare reimbursement reference rate of $103.79, this hospital’s rate is 1.70x the Medicare baseline. Located in 11234 Anderson Street Suite A, Loma Linda, CA.

Cash / Self-Pay

$181

Average discount available for prompt cash payment at this facility.

Insurance Median

$176

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: $181 (174%)

Insurance Median: $176 (170%)

Cash: $181 (174% of Medicare)

Ins. Median: $176 (170% 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
Inland Empire Health Plan (Iehp)	$40 - $118	39%
Kaiser Foundation Hospitals	$46 - $268	44%
Adventist Health	$80	77%
Lluh Dept Of Risk Management	$96	92%
Alpha Care Medical Group	$118 - $176	114%
Dignity Health	$118 - $176	114%
Epic Health Plan	$118 - $161	114%
Upland Medical Group	$118	114%
Vantage Medical Group	$118 - $176	114%
Molina Healthcare Of Ca	$148 - $157	143%
Heritage Provider Network	$193	186%
UnitedHealthcare	$201	194%
Global Benefits Group	$241	232%
Temecula Valley Physicians Medical Group	$241	232%
Trivalley Medical Group	$241	232%
Blue Cross Blue Shield	$247	238%
Cigna	$257 - $297	248%
Networks By Design	$261	251%
Aetna	$264	254%
Multiplan	$322	310%
Galaxy Health	$342	330%
Prime Health Services	$342	330%

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 $181.
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 Loma Linda University Children'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.