CMS Price Transparency Data

Group therapy session

Facility: Sullivan County Community Hospital

Billing Code: 90853 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90853
Insurance Median: $47
Cash Discount Price: $55
vs. Medicare Baseline: 0.45x Medicare

The contracted insurance negotiated median rate for a Group therapy session at Sullivan County Community Hospital is $47. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $55. Compared to the federal Medicare reimbursement reference rate of $103.79, this hospital’s rate is 0.45x the Medicare baseline. Located in 2200 N Section St, Sullivan, IN.

Cash / Self-Pay

$55

Average discount available for prompt cash payment at this facility.

Insurance Median

$47

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: $55 (53%)

Insurance Median: $47 (45%)

Cash: $55 (53% of Medicare)

Ins. Median: $47 (45% 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
Ambetter / Centene	$18 - $121	17%
Blue Cross Blue Shield	$18 - $213	17%
Humana	$18 - $404	17%
Mdwise Mcr Adv	$18 - $121	17%
Mhs Hlthy In Mcaid	$24 - $104	23%
UnitedHealthcare	$24 - $62	23%
Va Ccn - All Plans	$24	23%
Mdwise Mcaid - All Other Plans	$27 - $404	26%
Mhs Mcaid - All Other Plans	$27 - $404	26%
Siho - All Plans	$44 - $303	42%

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 $55.
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 Sullivan County Community 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.