Group therapy session
Facility: Boston Children's Hospital
Billing Code: 90853 (CPT)
- CPT Billing Code: 90853
- Insurance Median: $123
- Cash Discount Price: $164
- vs. Medicare Baseline: 1.19x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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.
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% |
| United | $98 - $137 | 94% |
| Aetna | $98 - $137 | 94% |
| Mgb/Allways | $100 - $121 | 96% |
| Tufts Public Plan | $101 | 97% |
| United Ri Nj Ny | $103 | 99% |
| Ambetter / Centene | $104 | 100% |
| UnitedHealthcare | $107 - $139 | 103% |
| Carelon Strategies/Bhs | $107 | 103% |
| Carelon/Beacon | $123 | 119% |
| Fallon | $125 - $126 | 120% |
| Health New England | $133 | 128% |
| Interlink Transplant | $139 | 134% |
| Ets/Lifetrac | $139 | 134% |
| Cigna | $139 - $164 | 134% |
| Humana | $148 | 143% |
| Community Health Options | $148 | 143% |
| Coventry/Hcvm/First Health | $151 | 145% |
| Multiplan/Phcs | $151 - $156 | 145% |
Consumer Guidance & Cost Commentary
Boston Children's Hospital, located at 300 Longwood Avenue in Boston, MA, provides a Group therapy session (CPT code 90853) for a cash and self-pay price of $164. This cash rate is identical to the facility's gross chargemaster price and exceeds the median negotiated rate of $123 found across 21 different payers. While the facility is a voluntary non-profit private children's hospital, no specific facility rating is available in the current dataset. For patients with high-deductible plans, paying the $164 upfront may be more cost-effective than relying on insurance, as the negotiated rates from major carriers like Cigna and UnitedHealthcare range from $107 to $139, which are lower than the cash price but still subject to deductibles and copays.
The Medicare benchmark for this service is $103.79, meaning the cash price represents a markup of 1.2 times the Medicare rate. Although the data does not provide explicit state or county average comparisons for this specific code, the facility's negotiated rates vary significantly by insurer, with the lowest allowed amounts starting at $80 (Cdphp) and the highest at $139 (Cdphp, Ets/Lifetrac, and Interlink Transplant). Patients should verify their specific plan's negotiated rate before scheduling, as some insurers like Tufts Public Plan and United Ri Nj Ny offer a flat allowed amount of $101 and $103 respectively, which could result in lower out-of-pocket costs if the patient's deductible is met. Additionally, patients should inquire about "prompt-pay" discounts or self-pay reductions prior