CMS Price Transparency Data

Group therapy session

Facility: Pulaski Memorial Hospital

Billing Code: 90853 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90853
Insurance Median: $336
Cash Discount Price: $359
vs. Medicare Baseline: 3.24x Medicare

The contracted insurance negotiated median rate for a Group therapy session at Pulaski Memorial Hospital is $336. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $359. Compared to the federal Medicare reimbursement reference rate of $103.79, this hospital’s rate is 3.24x the Medicare baseline. Located in 616 E 13Th St, Winamac, IN.

Cash / Self-Pay

$359

Average discount available for prompt cash payment at this facility.

Insurance Median

$336

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: $359 (346%)

Insurance Median: $336 (324%)

Cash: $359 (346% of Medicare)

Ins. Median: $336 (324% 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 324% of the Medicare baseline (a markup of 224%). 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
Ambetter / Centene	$159	153%
Blue Cross Blue Shield	$159 - $513	153%
Caresource Mcaid Hip	$159	153%
Caresource Mcare Hmo	$159	153%
Cenpatico Mcaid Hip	$159	153%
Mdwise Mcaid Hip - All Other Plans	$159	153%
Mhs Mcaid Hip	$159	153%
UnitedHealthcare	$159 - $513	153%
Humana	$161 - $412	155%
Mhs Mcare Allwell	$161	155%
Aetna	$185	178%
Caresource Exch Hmo Hix - All Other Plans	$199	192%
Sagamore Rose Acre	$382	368%
Sagamore - All Other Plans	$388	374%
Encore Ppo - All Other Plans	$436	420%
Community Health Alliance - All Plans	$457	440%
Encore Workers Comp	$462	445%
Multiplan - All Plans	$462	445%
Cigna	$487	469%
Caresource Mcaid Hhw	$513	494%
Cenpatico Mcaid Hhw - All Other Plans	$513	494%
Mdwise Mcaid Hcc	$513	494%
Mdwise Mcaid Hhw	$513	494%
Mhs Mcaid Hhw/Hcc	$513	494%

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 $359.
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 Pulaski Memorial 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.