CMS Price Transparency Data

Group therapy session

Facility: Lewisgale Hospital Pulaski

Billing Code: 90853 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90853
Insurance Median: $1,354
Cash Discount Price: $1,842
vs. Medicare Baseline: 13.05x Medicare

The contracted insurance negotiated median rate for a Group therapy session at Lewisgale Hospital Pulaski is $1,354. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,842. Compared to the federal Medicare reimbursement reference rate of $103.79, this hospital’s rate is 13.05x the Medicare baseline. Located in 2400 Lee Highway, Pulaski, VA.

Cash / Self-Pay

$1,842

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,354

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: $1,842 (1775%)

Insurance Median: $1,354 (1305%)

Cash: $1,842 (1775% of Medicare)

Ins. Median: $1,354 (1305% 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 1305% of the Medicare baseline (a markup of 1205%). 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
Lifeworks	$350	337%
Universal Healthcare Group	$405	390%
United	$615 - $829	593%
Virginia Health Network	$645 - $1,308	621%
Aetna	$663 - $829	639%
Cigna	$764	736%
Greenvbrier Sporting Club	$1,105	1065%
Corvel	$1,326	1278%
Richfield Nursing Center	$1,382	1332%
Richfield Retirement Community	$1,382	1332%
Multiplan	$1,418	1366%
Community Care Network	$1,474	1420%
Graham-White Manufacturing	$1,474	1420%
Occunet Workers Comp	$1,474	1420%
One Health Plan	$1,474	1420%
Patients Choice	$1,621	1562%
4Most	$1,658	1597%
American Postal Workers Union	$1,658	1597%
Phcs	$1,658	1597%
Star Transportation	$1,658	1597%

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 $1,842.
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 Lewisgale Hospital Pulaski 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.