CMS Price Transparency Data

Group therapy session

Facility: Elkhart General Hospital

Billing Code: 90853 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90853
Insurance Median: $106
Cash Discount Price: $98
vs. Medicare Baseline: 1.02x Medicare

The contracted insurance negotiated median rate for a Group therapy session at Elkhart General Hospital is $106. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $98. Compared to the federal Medicare reimbursement reference rate of $103.79, this hospital’s rate is 1.02x the Medicare baseline. Located in 600 E Blvd, Elkhart, IN.

Cash / Self-Pay

$98

Average discount available for prompt cash payment at this facility.

Insurance Median

$106

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: $98 (94%)

Insurance Median: $106 (102%)

Cash: $98 (94% of Medicare)

Ins. Median: $106 (102% 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
Devoted Healthcare	$30 - $102	29%
Blue Cross Blue Shield	$32 - $289	31%
Mclaren (Mi	$52	50%
UnitedHealthcare	$52 - $101	50%
Aetna	$68 - $102	66%
Cha	$91 - $118	88%
Immergrun	$91 - $121	88%
Humana	$97 - $106	93%
Pace	$97	93%
Mhs	$98 - $196	94%
Php	$98 - $106	94%
Cigna	$109 - $115	105%
Multiplan	$109	105%
Signature	$110	106%
Encore	$112	108%
Plain Church	$121 - $145	117%
Heartland	$151	145%
Caresource	$155 - $196	149%
Mdwise	$196	189%

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 $98.
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 Elkhart General 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.