CMS Price Transparency Data

Group therapy session

Facility: Mercy Hospital Ada

Billing Code: 90853 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90853
Insurance Median: $510
Cash Discount Price: $553
vs. Medicare Baseline: 4.91x Medicare

The contracted insurance negotiated median rate for a Group therapy session at Mercy Hospital Ada is $510. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $553. Compared to the federal Medicare reimbursement reference rate of $103.79, this hospital’s rate is 4.91x the Medicare baseline. Located in 430 North Monte Vista, Ada, OK.

Cash / Self-Pay

$553

Average discount available for prompt cash payment at this facility.

Insurance Median

$510

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: $553 (533%)

Insurance Median: $510 (491%)

Cash: $553 (533% of Medicare)

Ins. Median: $510 (491% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 491% of the Medicare baseline (a markup of 391%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Blue Cross Blue Shield	$24 - $92	23%
Aetna	$25 - $639	24%
Humana	$25	24%
Medicaid / KanCare	$25	24%
Health Choice Contracted [320166]	$185	178%
Healthcare Highways Plus Contracted [320175]	$332 - $638	320%
Webtpa Contracted [320417]	$357	344%
Osma Health Contracted [320292]	$382	368%
UnitedHealthcare	$391 - $595	377%
Medica Contracted [320239]	$396 - $850	382%
Benefit Management Contracted [320052]	$425 - $552	409%
Aither Health Contracted [320449]	$510	491%
Auxiant Contracted [320462]	$510	491%
Ebms Contracted [320493]	$510	491%
Federal Medical Center Contracted [320127]	$510	491%
Healthlink Contracted [320179]	$510	491%
Healthscope Contracted [320182]	$510	491%
Imagine 360 Contracted [320494]	$510	491%
Mercy Benefit Admin Contracted [320251]	$510 - $552	491%
Point C Contracted [320238]	$510	491%
Preferred Health Plan Contracted [320522]	$510	491%
Quik Trip Contracted [320447]	$510	491%
Reflect Health Contracted [320492]	$510	491%
Show-Me Health Administrators Contracted [320483]	$510	491%
United Medical Resources Contracted [320454]	$510 - $595	491%
Workers Comp [20426]	$510	491%
Yuzu Health Contracted [320521]	$510	491%
Globalhealth Contracted [320144]	$536	516%
First Health Contracted [320128]	$706	680%
Multiplan Contracted [320270]	$722	696%
Private Health Care Systems Contracted [320320]	$722	696%
Medicare (plans)	$850	819%

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 $553.
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 Mercy Hospital Ada 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.