CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Adventist Health Tillamook

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $160
Cash Discount Price: $94
vs. Medicare Baseline: 1.68x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Adventist Health Tillamook is $160. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $94. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 1.68x the Medicare baseline. Located in 1000 Third Street, Tillamook, OR.

Cash / Self-Pay

$94

Average discount available for prompt cash payment at this facility.

Insurance Median

$160

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$95.19

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $95.19 (100%)

Cash / Self-Pay: $94 (99%)

Insurance Median: $160 (168%)

Cash: $94 (99% of Medicare)

Ins. Median: $160 (168% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $95.19 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
Devoted Health	$53 - $319	56%
Medicare (plans)	$70 - $298	74%
Moda Health Plan - All Plans	$70 - $298	74%
Aetna	$72 - $227	76%
Pacificsource - All Plans	$89 - $234	93%
Hvhs Mcare - All Plans	$94 - $301	99%
Blue Cross Blue Shield	$99 - $298	104%
Lifewise - All Plans	$106 - $220	111%
Ods Health Plan - All Other Plans	$109 - $237	115%
Ah Employee Health Plan - All Plans	$110 - $229	116%
First Choice Health- All Plans	$110 - $229	116%
Health Net - All Plans	$110 - $229	116%
Providence Preferred - All Plans	$115 - $239	121%
Workers Comp	$117 - $244	123%
UnitedHealthcare	$120	126%
Cigna	$232	244%
Phcs Preferred - All Plans	$232	244%
Sterling Life - All Plans	$310	326%

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 $94.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 99213.

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 99213.
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.