CMS Price Transparency Data

Office visit, established patient (30-39 min)

Facility: Adventist Health Tillamook

Billing Code: 99214 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99214
Insurance Median: $237
Cash Discount Price: $139
vs. Medicare Baseline: 1.75x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at Adventist Health Tillamook is $237. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $139. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 1.75x the Medicare baseline. Located in 1000 Third Street, Tillamook, OR.

Cash / Self-Pay

$139

Average discount available for prompt cash payment at this facility.

Insurance Median

$237

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$135.6

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $135.6 (100%)

Cash / Self-Pay: $139 (103%)

Insurance Median: $237 (175%)

Cash: $139 (103% of Medicare)

Ins. Median: $237 (175% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $135.6 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	$74 - $319	55%
Medicare (plans)	$98 - $298	72%
Moda Health Plan - All Plans	$98 - $298	72%
Aetna	$114 - $319	84%
Hvhs Mcare - All Plans	$131 - $301	97%
Pacificsource - All Plans	$138 - $329	102%
Blue Cross Blue Shield	$139 - $298	103%
Lifewise - All Plans	$148 - $309	109%
Ah Employee Health Plan - All Plans	$154 - $322	114%
First Choice Health- All Plans	$154 - $322	114%
Health Net - All Plans	$154 - $322	114%
Providence Preferred - All Plans	$161 - $336	119%
Workers Comp	$164 - $343	121%
Ods Health Plan - All Other Plans	$167 - $333	123%
UnitedHealthcare	$176	130%
Sterling Life - All Plans	$310	229%
Cigna	$326	240%
Phcs Preferred - All Plans	$326	240%

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 $139.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 99214.

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 99214.
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.