CMS Price Transparency Data

Group therapy session

Facility: Punxsutawney Area Hospital

Billing Code: 90853 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90853
Insurance Median: $92
Cash Discount Price: $69
vs. Medicare Baseline: 0.89x Medicare

The contracted insurance negotiated median rate for a Group therapy session at Punxsutawney Area Hospital is $92. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $69. Compared to the federal Medicare reimbursement reference rate of $103.79, this hospital’s rate is 0.89x the Medicare baseline. Located in 81 Hillcrest Drive, Punxsutawney, PA.

Cash / Self-Pay

$69

Average discount available for prompt cash payment at this facility.

Insurance Median

$92

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: $69 (66%)

Insurance Median: $92 (89%)

Cash: $69 (66% of Medicare)

Ins. Median: $92 (89% 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
Highmark Wholecare	$18 - $99	17%
Highmark	$21 - $596	20%
Tricare	$25 - $96	24%
UnitedHealthcare	$26 - $110	25%
Aetna	$29 - $233	28%
Amerihealth Caritas	$29 - $104	28%
Geisinger Health Plan	$30 - $106	29%
United Mine Workers Of America	$30 - $106	29%
Upmc Health Plan	$30 - $276	29%
Ambetter / Centene	$31 - $112	30%
Pa Health And Wellness Commercial	$37 - $212	36%
Geisinger	$42 - $297	40%
Cigna	$57 - $164	55%
Pa Workers Compensation	$96 - $276	92%
Humana	$104	100%

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 $69.
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 Punxsutawney Area 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.