CMS Price Transparency Data

Inguinal hernia repair

Facility: Adventist Health Tillamook

Billing Code: 49505 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 49505
Insurance Median: $1,827
Cash Discount Price: $1,640
vs. Medicare Baseline: 0.50x Medicare

The contracted insurance negotiated median rate for a Inguinal hernia repair at Adventist Health Tillamook is $1,827. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,640. Compared to the federal Medicare reimbursement reference rate of $3,657.95, this hospital’s rate is 0.50x the Medicare baseline. Located in 1000 Third Street, Tillamook, OR.

Cash / Self-Pay

$1,640

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,827

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$3,657.95

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $3,657.95 (100%)

Cash / Self-Pay: $1,640 (45%)

Insurance Median: $1,827 (50%)

Cash: $1,640 (45% of Medicare)

Ins. Median: $1,827 (50% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $3,657.95 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	$487 - $774	13%
Moda Health Plan - All Plans	$497	14%
Sterling Life - All Plans	$506	14%
Medicare (plans)	$511	14%
Devoted Health	$526	14%
Blue Cross Blue Shield	$560 - $3,524	15%
Hvhs Mcare - All Plans	$589	16%
Pacificsource - All Plans	$924	25%
UnitedHealthcare	$1,032	28%
Ods Health Plan - All Other Plans	$1,138	31%
Lifewise - All Plans	$1,827 - $3,653	50%
Ah Employee Health Plan - All Plans	$1,904 - $3,807	52%
First Choice Health- All Plans	$1,904 - $3,807	52%
Health Net - All Plans	$1,904 - $3,807	52%
Providence Preferred - All Plans	$1,984 - $3,969	54%
Workers Comp	$2,025 - $4,050	55%

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 $1,640.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 49505.

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 49505.
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.