CMS Price Transparency Data

Digestive disorders treatment (inpatient stay)

Facility: Adventist Health Tillamook

Billing Code: 392 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 392
Insurance Median: $23,927
Cash Discount Price: $13,819
vs. Medicare Baseline: 4.22x Medicare

The contracted insurance negotiated median rate for a Digestive disorders treatment (inpatient stay) at Adventist Health Tillamook is $23,927. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $13,819. Compared to the federal Medicare reimbursement reference rate of $5,675.87, this hospital’s rate is 4.22x the Medicare baseline. Located in 1000 Third Street, Tillamook, OR.

Cash / Self-Pay

$13,819

Average discount available for prompt cash payment at this facility.

Insurance Median

$23,927

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$5,675.87

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $5,675.87 (100%)

Cash / Self-Pay: $13,819 (243%)

Insurance Median: $23,927 (422%)

Cash: $13,819 (243% of Medicare)

Ins. Median: $23,927 (422% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $5,675.87 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 422% of the Medicare baseline (a markup of 322%). 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
Aetna	$9,260 - $23,800	163%
Blue Cross Blue Shield	$17,583 - $22,264	310%
Medicare (plans)	$17,583	310%
Moda Health Plan - All Plans	$17,583	310%
Sterling Life - All Plans	$18,286	322%
Lifewise - All Plans	$23,083	407%
Devoted Health	$23,456	413%
Ah Employee Health Plan - All Plans	$24,055	424%
First Choice Health- All Plans	$24,055	424%
Health Net - All Plans	$24,055	424%
Cigna	$24,311	428%
Phcs Preferred - All Plans	$24,311	428%
UnitedHealthcare	$24,311	428%
Ods Health Plan - All Other Plans	$24,823	437%
Providence Preferred - All Plans	$25,079	442%
Workers Comp	$25,591	451%
Hvhs Mcare - All Plans	$30,145	531%

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 $13,819.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify MS-DRG Code matches exactly: 392.

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 MS-DRG code 392.
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.