CMS Price Transparency Data

Group therapy session

Facility: St Charles Medical Center - Bend

Billing Code: 90853 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90853
Insurance Median: $276
Cash Discount Price: $276
vs. Medicare Baseline: 2.66x Medicare

The contracted insurance negotiated median rate for a Group therapy session at St Charles Medical Center - Bend is $276. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $276. Compared to the federal Medicare reimbursement reference rate of $103.79, this hospital’s rate is 2.66x the Medicare baseline. Located in 2500 Ne Neff Road, Bend, OR.

Cash / Self-Pay

$276

Average discount available for prompt cash payment at this facility.

Insurance Median

$276

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: $276 (266%)

Insurance Median: $276 (266%)

Cash: $276 (266% of Medicare)

Ins. Median: $276 (266% 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 266% of the Medicare baseline (a markup of 166%). 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
Tricare	$113	109%
Generic Workers Comp [699]	$119	115%
Medicaid / KanCare	$119	115%
Otj Broadspire Services [670]	$119	115%
Otj Ccmsi [618]	$119	115%
Otj Chartis Claims [650]	$119	115%
Otj City County Ins Services [662]	$119	115%
Otj Corvel [676]	$119	115%
Otj Esis West Wc Claims [653]	$119	115%
Otj Gallagher Bassett [654]	$119	115%
Otj Hartford [655]	$119	115%
Otj Intermountain Claims Inc [666]	$119	115%
Otj Liberty Mutual Wausau Underwriters [671]	$119	115%
Otj Penser No American [663]	$119	115%
Otj Pinnacle Risk Mgmt [661]	$119	115%
Otj Saif [659]	$119	115%
Otj Saif [667]	$119	115%
Otj Sedgwick Cms [660]	$119	115%
Otj Sedgwick [668]	$119	115%
Otj Travelers Insurance [672]	$119	115%
Otj Tristar [673]	$119	115%
Pacificsource [345]	$138 - $188	133%
Law Enforcement [701]	$171	165%
Cigna	$217	209%
Us Benefits [326]	$217	209%
Blue Cross Blue Shield	$231 - $272	223%
Bridgespan [342]	$231	223%
Providence Health Plan [347]	$241 - $301	232%
Asuris Northwest Health [202]	$272	262%
Healthcare Management Admin [201]	$272	262%
Regence Group Administrators [203]	$272	262%
Rocky Mountain Administrators [405]	$276	266%
Rx Internal [4100003]	$281	271%
Moda [310]	$296	285%
First Choice Health [317]	$298	287%
Kaiser Permanente [334]	$298	287%
Samaritan [376]	$298	287%
Aetna	$300	289%
Meritain Health [300]	$300	289%
Auto Allstate Insurance [602]	$310	299%
Auto American Family Insurance [603]	$310	299%
Auto Country Insurance Claims [604]	$310	299%
Auto Dairyland Insurance [617]	$310	299%
Auto Farmers [605]	$310	299%
Auto Geico Claims Oregon [606]	$310	299%
Auto Hartford [612]	$310	299%
Auto Liberty Mutual Auto Ins [613]	$310	299%
Auto Mutual Of Enumclaw [610]	$310	299%
Auto Nationwide Allied Insuranc [601]	$310	299%
Auto Oregon Mutual [614]	$310	299%
Auto Progressive [608]	$310	299%
Auto Safeco Concentra [600]	$310	299%
Auto State Farm Claims [609]	$310	299%
Auto Sublimity Insurance [616]	$310	299%
Auto Travelers Insurance [615]	$310	299%
Auto Usaa [611]	$310	299%
Generic Auto [649]	$310	299%
Health Net [340]	$324	312%
Administrative Concepts Inc [402]	$338	326%
First Health [339]	$338	326%
Manhattan Life Insurance Company [379]	$338	326%
Philadelphia American Life Insurance Company [395]	$338	326%
Planned Administrators Inc [375]	$338	326%

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 $276.
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 St Charles Medical Center - Bend 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.