CMS Price Transparency Data

Group therapy session

Facility: Adventist Health Tillamook

Billing Code: 90853 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90853
Insurance Median: $31
Cash Discount Price: $28
vs. Medicare Baseline: 0.30x Medicare

The contracted insurance negotiated median rate for a Group therapy session at Adventist Health Tillamook is $31. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $28. Compared to the federal Medicare reimbursement reference rate of $103.79, this hospital’s rate is 0.30x the Medicare baseline. Located in 1000 Third Street, Tillamook, OR.

Cash / Self-Pay

$28

Average discount available for prompt cash payment at this facility.

Insurance Median

$31

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: $28 (27%)

Insurance Median: $31 (30%)

Cash: $28 (27% of Medicare)

Ins. Median: $31 (30% 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
Blue Cross Blue Shield	$16 - $61	15%
Hvhs Mcare - All Plans	$16 - $29	15%
Medicare (plans)	$16 - $25	15%
Moda Health Plan - All Plans	$16 - $25	15%
Sterling Life - All Plans	$16 - $25	15%
Aetna	$17 - $49	16%
Devoted Health	$17 - $26	16%
Lifewise - All Plans	$30 - $63	29%
Ah Employee Health Plan - All Plans	$31 - $66	30%
Cigna	$31	30%
First Choice Health- All Plans	$31 - $66	30%
Health Net - All Plans	$31 - $66	30%
Phcs Preferred - All Plans	$31	30%
UnitedHealthcare	$31 - $51	30%
Ods Health Plan - All Other Plans	$32 - $52	31%
Pacificsource - All Plans	$32 - $58	31%
Providence Preferred - All Plans	$32 - $69	31%
Workers Comp	$33 - $70	32%

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 $28.
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 Adventist Health Tillamook 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.