CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Adventist Health Tillamook

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $29
Cash Discount Price: $25
vs. Medicare Baseline: 0.13x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Adventist Health Tillamook is $29. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $25. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.13x the Medicare baseline. Located in 1000 Third Street, Tillamook, OR.

Cash / Self-Pay

$25

Average discount available for prompt cash payment at this facility.

Insurance Median

$29

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$223.72

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $223.72 (100%)

Cash / Self-Pay: $25 (11%)

Insurance Median: $29 (13%)

Cash: $25 (11% of Medicare)

Ins. Median: $29 (13% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $223.72 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
Aetna	$9 - $235	4%
Devoted Health	$9 - $128	4%
Medicare (plans)	$9 - $119	4%
Moda Health Plan - All Plans	$9 - $119	4%
Sterling Life - All Plans	$9 - $124	4%
Blue Cross Blue Shield	$10 - $220	4%
Hvhs Mcare - All Plans	$10 - $120	4%
UnitedHealthcare	$18 - $240	8%
Lifewise - All Plans	$26 - $228	12%
Ah Employee Health Plan - All Plans	$27 - $238	12%
First Choice Health- All Plans	$27 - $238	12%
Health Net - All Plans	$27 - $238	12%
Pacificsource - All Plans	$27 - $243	12%
Cigna	$28 - $240	13%
Ods Health Plan - All Other Plans	$28 - $245	13%
Phcs Preferred - All Plans	$28 - $240	13%
Providence Preferred - All Plans	$28 - $248	13%
Workers Comp	$29 - $253	13%

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 $25.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 94640.

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 94640.
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.