CMS Price Transparency Data

Group therapy session

Facility: The Children's Mercy Hospital

Billing Code: 90853 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90853
Insurance Median: $65
Cash Discount Price: $71
vs. Medicare Baseline: 0.63x Medicare

The contracted insurance negotiated median rate for a Group therapy session at The Children's Mercy Hospital is $65. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $71. Compared to the federal Medicare reimbursement reference rate of $103.79, this hospital’s rate is 0.63x the Medicare baseline. Located in 2401 Gillham Road, Kansas City, MO.

Cash / Self-Pay

$71

Average discount available for prompt cash payment at this facility.

Insurance Median

$65

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: $71 (68%)

Insurance Median: $65 (63%)

Cash: $71 (68% of Medicare)

Ins. Median: $65 (63% 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	$26 - $221	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%
Humana	$46 - $146	44%
Nebraska Furniture Mart	$46 - $143	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%
Coventry Health Care Of Kansas	$65 - $163	63%
National Preferred Provider Network	$65 - $198	63%

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 $71.
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 The Children's Mercy 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.