Group therapy session
Facility: Children'S Mercy South
Billing Code: 90853 (CPT)
- CPT Billing Code: 90853
- Insurance Median: $65
- Cash Discount Price: $71
- vs. Medicare Baseline: 0.63x 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 |
|---|---|---|
| UnitedHealthcare | $26 - $148 | 25% |
| Healthy Blue | $28 - $221 | 27% |
| Medicaid / KanCare | $28 - $99 | 27% |
| Healthlink | $30 - $194 | 29% |
| Health Midwest Comprehensive Care | $32 - $143 | 31% |
| Wppa Providrs Care | $32 - $143 | 31% |
| Home State Health | $34 - $194 | 33% |
| American Healthcare Alliance | $35 - $187 | 34% |
| Quiktrip | $40 - $143 | 39% |
| Medica | $43 - $128 | 41% |
| Blue Cross Blue Shield | $44 - $163 | 42% |
| Wellfit/Centrus | $44 - $143 | 42% |
| Centivo | $45 - $143 | 43% |
| Nebraska Furniture Mart | $46 - $143 | 44% |
| Humana | $46 - $146 | 44% |
| Orscheln | $47 - $143 | 45% |
| Aetna | $51 - $150 | 49% |
| Multiplan | $53 - $167 | 51% |
| Mercy Health | $54 - $165 | 52% |
| Coxhealth Network | $55 - $163 | 53% |
| Cigna | $62 - $153 | 60% |
| National Preferred Provider Network | $65 - $198 | 63% |
| Coventry Health Care Of Kansas | $65 - $163 | 63% |
Consumer Guidance & Cost Commentary
For this group therapy session (CPT 90853) at Children's Mercy South in Overland Park, KS, the facility's cash price is $71.00, which is lower than the state average of $103.79 (Medicare rate). While many insurance plans negotiate rates ranging from $26 to $198, these amounts often exceed the cash price, meaning patients with high-deductible plans might save money by paying out-of-pocket and seeking a prompt-pay discount. It is important to verify your specific plan's negotiated rate before scheduling, as some in-network carriers may pay significantly more than the cash price due to administrative costs and contract dynamics. If you are self-pay, ask the billing department directly about self-pay or prompt-pay discounts, which can reduce the final amount owed.
Patients should be aware that commercial negotiated rates often include administrative overhead and do not represent the true cost of care; comparing these rates to the Medicare benchmark of $103.79 reveals the actual markup. If you receive a bill from an out-of-network provider at this facility, the No Surprises Act protects you from balance billing for non-emergency services, so you should dispute any surprise charges in writing rather than paying immediately. Furthermore, if you receive a summary bill, request a full itemized audit to identify errors, unbundled codes, or services not rendered, as over 80% of hospital bills contain mistakes that can be corrected through a formal written dispute sent to the billing supervisor.