CMS Price Transparency Data

CT scan, pelvis

Facility: Adventist Health Tillamook

Billing Code: 72192 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72192
Insurance Median: $959
Cash Discount Price: $675
vs. Medicare Baseline: 8.98x Medicare

The contracted insurance negotiated median rate for a CT scan, pelvis at Adventist Health Tillamook is $959. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $675. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 8.98x the Medicare baseline. Located in 1000 Third Street, Tillamook, OR.

Cash / Self-Pay

$675

Average discount available for prompt cash payment at this facility.

Insurance Median

$959

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$106.81

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $106.81 (100%)

Cash / Self-Pay: $675 (632%)

Insurance Median: $959 (898%)

Cash: $675 (632% of Medicare)

Ins. Median: $959 (898% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $106.81 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 898% of the Medicare baseline (a markup of 798%). 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
UnitedHealthcare	$42 - $1,699	39%
Aetna	$49 - $1,663	46%
Moda Health Plan - All Plans	$50 - $840	47%
Sterling Life - All Plans	$51 - $874	48%
Medicare (plans)	$52 - $840	49%
Devoted Health	$53 - $908	50%
Blue Cross Blue Shield	$56 - $1,556	52%
Hvhs Mcare - All Plans	$59 - $849	55%
Pacificsource - All Plans	$112 - $1,716	105%
Ods Health Plan - All Other Plans	$116 - $1,734	109%
Lifewise - All Plans	$259 - $1,613	242%
Ah Employee Health Plan - All Plans	$270 - $1,681	253%
First Choice Health- All Plans	$270 - $1,681	253%
Health Net - All Plans	$270 - $1,681	253%
Providence Preferred - All Plans	$282 - $1,752	264%
Workers Comp	$288 - $1,788	270%
Cigna	$1,102 - $1,699	1032%
Phcs Preferred - All Plans	$1,102 - $1,699	1032%

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 $675.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 72192.

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 72192.
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.