CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Adventist Health Tillamook

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $72,465
Cash Discount Price: $41,852
vs. Medicare Baseline: 5.16x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Adventist Health Tillamook is $72,465. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $41,852. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 5.16x the Medicare baseline. Located in 1000 Third Street, Tillamook, OR.

Cash / Self-Pay

$41,852

Average discount available for prompt cash payment at this facility.

Insurance Median

$72,465

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$14,044.15

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $14,044.15 (100%)

Cash / Self-Pay: $41,852 (298%)

Insurance Median: $72,465 (516%)

Cash: $41,852 (298% of Medicare)

Ins. Median: $72,465 (516% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $14,044.15 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 516% of the Medicare baseline (a markup of 416%). 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	$15,434 - $72,078	110%
Blue Cross Blue Shield	$29,305 - $67,428	209%
Medicare (plans)	$29,305	209%
Moda Health Plan - All Plans	$29,305	209%
Sterling Life - All Plans	$30,477	217%
Devoted Health	$55,112	392%
Lifewise - All Plans	$69,908	498%
Ah Employee Health Plan - All Plans	$72,853	519%
First Choice Health- All Plans	$72,853	519%
Health Net - All Plans	$72,853	519%
Cigna	$73,628	524%
Phcs Preferred - All Plans	$73,628	524%
UnitedHealthcare	$73,628	524%
Ods Health Plan - All Other Plans	$75,178	535%
Providence Preferred - All Plans	$75,953	541%
Workers Comp	$77,503	552%
Hvhs Mcare - All Plans	$78,720	561%

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 $41,852.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify MS-DRG Code matches exactly: 470.

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 470.
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.