CMS Price Transparency Data

Group therapy session

Facility: Boston Children's Hospital

Billing Code: 90853 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90853
Insurance Median: $123
Cash Discount Price: $164
vs. Medicare Baseline: 1.19x Medicare

The contracted insurance negotiated median rate for a Group therapy session at Boston Children's Hospital is $123. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $164. Compared to the federal Medicare reimbursement reference rate of $103.79, this hospital’s rate is 1.19x the Medicare baseline. Located in 300 Longwood Avenue, Boston, MA.

Cash / Self-Pay

$164

Average discount available for prompt cash payment at this facility.

Insurance Median

$123

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: $164 (158%)

Insurance Median: $123 (119%)

Cash: $164 (158% of Medicare)

Ins. Median: $123 (119% 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
Cdphp	$80 - $139	77%
Harvard Pilgrim	$83 - $111	80%
Blue Cross Blue Shield	$92 - $108	89%
Aetna	$98 - $137	94%
United	$98 - $137	94%
Mgb/Allways	$100 - $121	96%
Tufts Public Plan	$101	97%
United Ri Nj Ny	$103	99%
Ambetter / Centene	$104	100%
Carelon Strategies/Bhs	$107	103%
UnitedHealthcare	$107 - $139	103%
Carelon/Beacon	$123	119%
Fallon	$125 - $126	120%
Health New England	$133	128%
Cigna	$139 - $164	134%
Ets/Lifetrac	$139	134%
Interlink Transplant	$139	134%
Community Health Options	$148	143%
Humana	$148	143%
Coventry/Hcvm/First Health	$151	145%
Multiplan/Phcs	$151 - $156	145%

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 $164.
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 Boston 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.