CMS Price Transparency Data

Group therapy session

Facility: Cook Childrens Medical Center

Billing Code: 90853 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90853
Insurance Median: $197
Cash Discount Price: $1,172
vs. Medicare Baseline: 1.90x Medicare

The contracted insurance negotiated median rate for a Group therapy session at Cook Childrens Medical Center is $197. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,172. Compared to the federal Medicare reimbursement reference rate of $103.79, this hospital’s rate is 1.90x the Medicare baseline. Located in 801 Seventh Avenue, Fort Worth, TX.

Cash / Self-Pay

$1,172

Average discount available for prompt cash payment at this facility.

Insurance Median

$197

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: $1,172 (1129%)

Insurance Median: $197 (190%)

Cash: $1,172 (1129% of Medicare)

Ins. Median: $197 (190% 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
Health Plan W. Uhrip	$20 - $1,105	19%
Health Plan W/O Uhrip	$20 - $697	19%
Aetna	$29 - $2,470	28%
Beacon	$53 - $1,278	51%
Firstcare	$53 - $2,324	51%
Rightcare	$73 - $1,278	70%
United Community	$77 - $1,021	74%
Wellpoint	$77 - $1,021	74%
Blue Cross Blue Shield	$79 - $2,615	76%
Molina	$81 - $1,075	78%
El Paso Health First	$97 - $1,278	93%
Superior Health	$97 - $1,278	93%
UnitedHealthcare	$97 - $2,470	93%
S&W Health	$184 - $2,441	177%
Cigna	$186 - $2,470	179%
Healthscope	$186 - $2,470	179%
Imagine Health	$186 - $2,470	179%
Humana	$191 - $2,557	184%
Multiplan	$191 - $2,528	184%
First Health	$193 - $2,557	186%
Galaxy Health	$197 - $2,615	190%
Healthsmart	$197 - $2,615	190%
Usamco	$202 - $2,673	195%
Tx Children Health	$1,278	1231%

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 $1,172.
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 Cook Childrens Medical Center 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.