CMS Price Transparency Data

Group therapy session

Facility: Childrens Hospital of the Kings Daughters Inc

Billing Code: 90853 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90853
Insurance Median: $64
Cash Discount Price: $75
vs. Medicare Baseline: 0.62x Medicare

The contracted insurance negotiated median rate for a Group therapy session at Childrens Hospital of the Kings Daughters Inc is $64. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $75. Compared to the federal Medicare reimbursement reference rate of $103.79, this hospital’s rate is 0.62x the Medicare baseline. Located in 601 Children's Lane, Norfolk, VA.

Cash / Self-Pay

$75

Average discount available for prompt cash payment at this facility.

Insurance Median

$64

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: $75 (72%)

Insurance Median: $64 (62%)

Cash: $75 (72% of Medicare)

Ins. Median: $64 (62% 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
Johns Hopkins Healthcare	$3 - $87	3%
Blue Cross Blue Shield	$21 - $376	20%
Sentara Community Plan	$21 - $443	20%
UnitedHealthcare	$21 - $379	20%
Humana	$25 - $464	24%
Carolina Complete Health	$26	25%
Aetna	$27 - $464	26%
Sentara Health Plans	$27 - $36	26%
Trillium Behavioral Health	$34	33%
Evernorth	$41 - $58	40%
Virginia Health Network	$52 - $73	50%
Medcost	$64 - $84	62%
First Health	$68 - $83	66%
Multiplan	$69 - $84	66%
Phcs	$71 - $87	68%
Vhn	$71 - $87	68%

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 $75.
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 Childrens Hospital of the Kings Daughters Inc 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.