NORTHWEST MEDICAL FOUNDATION OF TILLAMOOK
1000 3rd St, Tillamook, OR · Adventisthealth · · NPI 1871575225
Published prices by procedure
Cash price is what you pay without insurance. The negotiated range spans the lowest to highest rate this hospital agreed with insurers.
| Procedure | Cash price | Gross charge | Negotiated range | Payers |
|---|---|---|---|---|
| Leg Vein Ultrasound (DVT study, both legs) CPT 93970 | $115.02 | $213.00 | $31.44 – $73.50 | 11 |
| Leucovorin calcium 100 mg solution for injection (1 mg rounding) HCPCS J0640 | $88.56 | $164.01 | $85.20 – $85.20 | 1 |
| Leuprolide 30 mg (4 month) intramuscular syringe kit HCPCS J9217 | $8,344.79 | $15,453.31 | $941.00 – $941.00 | 1 |
| Leuprolide 3.75 mg intramuscular syringe kit HCPCS J1950 | $833.76 | $1,544.00 | $808.00 – $808.00 | 1 |
| Levetiracetam 500 mg/5 ml intravenous solution HCPCS J1953 | $11.01 | $20.39 | $20.39 – $20.39 | 1 |
| Levofloxacin 250 mg/50 ml in 5 % dextrose intravenous piggyback HCPCS J1956 | $23.49 | $43.50 | $39.00 – $39.00 | 1 |
| Levothyroxine 100 mcg intravenous powder for solution HCPCS J0650 | $210.58 | $389.97 | $389.97 – $389.97 | 1 |
| Lidocaine (pf) 10 mg/ml (1 %) injection solution HCPCS J2003 | $27.54 | $51.01 | $37.00 – $37.00 | 1 |
| Ligate oviduct(s) add-on 58611 CPT 58611 | $165.78 | $307.00 | $62.71 – $168.00 | 11 |
| Ligate/strip short leg vein CPT 37718 | $845.37 | $1,565.50 | $344.99 – $915.00 | 11 |
| Ligation/biopsy of temporal artery 37609 CPT 37609 | $635.04 | $1,176.00 | $181.33 – $445.50 | 11 |
| Ligation/divis of long saph vein 37700 CPT 37700 | $871.56 | $1,614.00 | $218.08 – $531.00 | 11 |
| Ligation of abdomen artery 37617 CPT 37617 | $2,903.85 | $5,377.50 | $1,148.99 – $2,896.50 | 11 |
| Ligation vericose vein cluster(s) 1 leg CPT 37785 | $965.52 | $1,788.00 | $224.32 – $559.50 | 11 |
| Liletta, 52 mg HCPCS J7297 | $514.62 | $953.00 | $47.00 – $1,000.65 | 6 |
| Linezolid in 5% dextrose in water 600 mg/300 ml intravenous piggyback HCPCS J2020 | $43.71 | $80.94 | $80.94 – $80.94 | 1 |
| Liver/spleen imag static only CPT 78215 | $85.32 | $158.00 | $19.03 – $51.00 | 11 |
| Lorazepam 2 mg/ml injection (wrapper) HCPCS J2060 | $27.00 | $50.00 | $50.00 – $50.00 | 1 |
| Lower Back (Lumbar Spine) CT scan (with and without contrast) CPT 72133 | $224.64 | $416.00 | $49.05 – $134.25 | 11 |
| Lower Back (Lumbar Spine) CT scan (with contrast) CPT 72132 | $215.46 | $399.00 | $47.06 – $129.75 | 11 |
| Lower Back (Lumbar Spine) CT scan (without contrast) CPT 72131 | $175.50 | $325.00 | $38.92 – $118.08 | 11 |
| Lower Back (Lumbar Spine) MRI (with and without contrast) CPT 72158 | $405.00 | $750.00 | $88.53 – $243.75 | 11 |
| Lower Back (Lumbar Spine) MRI (with contrast) CPT 72149 | $315.90 | $585.00 | $69.01 – $189.75 | 11 |
| Lower Back (Lumbar Spine) MRI (without contrast) CPT 72148 | $262.44 | $486.00 | $57.47 – $158.25 | 11 |
| Lower Back (Lumbar Spine) X-ray CPT 72100 | $148.50 | $275.00 | $10.58 – $24.00 | 11 |
| Lumizyme injection HCPCS J0221 | $86.40 | $160.00 | $160.00 – $160.00 | 1 |
| Lung Function Test (Spirometry) CPT 94010 | $49.14 | $91.00 | $8.24 – $18.00 | 11 |
| Lung perfusion imaging CPT 78580 | $128.52 | $238.00 | $28.31 – $77.25 | 11 |
| Luspatercept-aamt 25 mg subcutaneous solution HCPCS J0896 | $12,793.46 | $23,691.59 | $9,624.75 – $9,624.75 | 1 |
| Lymphatics/lymph node imaging CPT 78195 | $206.28 | $382.00 | $44.88 – $123.75 | 11 |
| Lysis of labial adhesions CPT 56441 | $380.70 | $705.00 | $136.99 – $318.00 | 11 |
| Lysis penil circumic lesion CPT 54162 | $538.38 | $997.00 | $179.96 – $431.25 | 11 |
| Magnesium sulfate 2 gram/50 ml (4 %) in water intravenous piggyback HCPCS J3475 | $29.50 | $54.62 | $28.83 – $28.83 | 1 |
| Makena, 10 mg HCPCS J1726 | $18.36 | $34.00 | $34.00 – $51.00 | 6 |
| Management of liver hemorrhage 47361 CPT 47361 | $6,114.96 | $11,324.00 | $2,638.05 – $6,624.75 | 11 |
| Mapping io sentinel lymph node CPT 38900 | $278.10 | $515.00 | $48.00 – $302.25 | 11 |
| Mastectomy partial CPT 19301 | $1,366.20 | $2,530.00 | $606.54 – $1,429.50 | 11 |
| Mast mod rad CPT 19307 | $2,499.12 | $4,628.00 | $1,080.12 – $2,623.50 | 11 |
| Mastoids complete CPT 70130 | $61.02 | $113.00 | $15.82 – $36.75 | 11 |
| Mast radical CPT 19305 | $2,359.26 | $4,369.00 | $1,051.48 – $2,478.75 | 11 |
| Mast simple complete CPT 19303 | $2,118.69 | $3,923.50 | $877.44 – $2,088.00 | 11 |
| Matrix tissue 15x10cm gentrix extra-gynecological clgn strl-cost per sq cm HCPCS Q4166 | $4,131.00 | $7,650.00 | $7,650.00 – $7,650.00 | 1 |
| Mayo mitotane (lysodren) therapeutic drug level CPT 80299 | $70.20 | $130.00 | $22.00 – $48.00 | 5 |
| Measurement post void urine by ultrasound CPT 51798 | $24.30 | $45.00 | $12.45 – $43.20 | 11 |
| Medroxyprogesterone 150 mg/ml im injection (wrapper) HCPCS J1050 | $43.20 | $80.00 | $0.65 – $84.00 | 6 |
| Membrane amnio clarix 4x3cm 1k -cost per sq cm HCPCS Q4155 | $4,050.00 | $7,500.00 | $3,513.00 – $3,513.00 | 1 |
| Mepolizumab 100 mg/ml subcutaneous auto-injector HCPCS J2182 | $15.12 | $28.00 | $28.00 – $28.00 | 1 |
| Meropenem 1 gram intravenous solution HCPCS J2185 | $21.77 | $40.32 | $39.00 – $39.00 | 1 |
| Mesh/prosth/ pelvic floor rpr/vag 57267 CPT 57267 | $547.83 | $1,014.50 | $211.24 – $550.50 | 11 |
| Metered dose inhaler drug HCPCS J3535 | $460.29 | $852.39 | $852.39 – $852.39 | 1 |
| Methylergonovine 0.2 mg/ml (1 ml) injection solution HCPCS J2210 | $52.08 | $96.45 | $96.45 – $96.45 | 1 |
| Methylnaltrexone 12 mg/0.6 ml subcutaneous injection (wrapper) HCPCS J2212 | $297.31 | $550.57 | $550.57 – $550.57 | 1 |
| Methylprednisolone acetate 40 mg/ml suspension for injection HCPCS J1010 | $17.28 | $32.00 | $7.95 – $8.35 | 3 |
| Methylprednisolone sodium succinate 1,000 mg intravenous solution HCPCS J2919 | $26.10 | $48.33 | $11.00 – $11.55 | 3 |
| Metoclopramide in d5w IV syringe 0.2 mg/ml (neo/ped) - cnr HCPCS J2765 | $20.31 | $37.61 | $1.06 – $48.00 | 6 |
| Metoprolol tartrate 5 mg/5 ml intravenous (wrapper) HCPCS J0616 | $21.06 | $39.00 | $39.00 – $39.00 | 1 |
| Metronidazole 500 mg/100 ml in sodium chlor(iso) intravenous piggyback HCPCS J1836 | $21.06 | $39.00 | $39.00 – $39.00 | 1 |
| Midazolam 1 mg/ml injection solution HCPCS J2250 | $27.00 | $50.00 | $0.18 – $48.00 | 6 |
| Mnl prep&insj dp rx dlvr dev CPT 20700 | $171.72 | $318.00 | $48.00 – $183.00 | 11 |
| Mnl prep&insj i-artic rx dev CPT 20704 | $307.80 | $570.00 | $48.00 – $317.25 | 11 |
| Mnpj anes sho jt fixj aprats CPT 23700 | $444.96 | $824.00 | $179.51 – $422.25 | 11 |
| Mnpj elbow under anes CPT 24300 | $957.42 | $1,773.00 | $437.54 – $927.19 | 11 |
| Mobilization of colon 44139 CPT 44139 | $256.50 | $475.00 | $101.95 – $264.00 | 11 |
| Mometasone sinus sinuva HCPCS J7402 | $1,459.62 | $2,703.00 | $2,703.00 – $2,703.00 | 1 |
| Monovisc inj per dose HCPCS J7327 | $935.28 | $1,732.00 | $47.00 – $1,818.60 | 6 |
| Morphine 4 mg/ml injection (wrapper) HCPCS J2270 | $26.65 | $49.36 | $2.65 – $48.00 | 6 |
| Morphine (pf) 0.25 mg/0.5 ml injection (neo/ped) - cnr HCPCS J2274 | $56.16 | $104.00 | $11.83 – $109.20 | 6 |
| Morphometric analysis tumor ihc qn/sq per specimen each single antibody stain manual CPT 88360 | $145.80 | $270.00 | $38.94 – $107.28 | 9 |
| MRA abdomen post contrast CPT 74185 | $315.90 | $585.00 | $81.33 – $189.75 | 11 |
| MRA aorta thoracic w/wo contrast CPT 71555 | $317.52 | $588.00 | $81.52 – $190.50 | 11 |
| MRA ext low(run-off)pst cntrst CPT 73725 | $317.52 | $588.00 | $81.66 – $191.25 | 11 |
| MRA pelvis CPT 72198 | $315.90 | $585.00 | $80.86 – $189.00 | 11 |
| MRA upper extremity post contrast-bil CPT 73225 | $307.26 | $569.00 | $76.99 – $185.25 | 11 |
| MRI breast c- unilateral CPT 77046 | $371.52 | $688.00 | $48.00 – $154.50 | 11 |
| MRI breast c-+ w/cad uni CPT 77048 | $371.52 | $688.00 | $48.00 – $222.75 | 9 |
| MRI breast w IV cont bi CPT 77049 | $406.62 | $753.00 | $48.00 – $244.50 | 9 |
| MRI chest without contrast CPT 71550 | $258.66 | $479.00 | $55.85 – $156.00 | 11 |
| MRI chest without & w/contrast CPT 71552 | $400.14 | $741.00 | $87.11 – $238.50 | 11 |
| MRI chest w IV cont CPT 71551 | $305.64 | $566.00 | $66.74 – $183.75 | 11 |
| MRI guid ndl plc s&i CPT 77021 | $261.90 | $485.00 | $69.47 – $155.25 | 9 |
| MRI loex nonjt w IV cont CPT 73719 | $286.74 | $531.00 | $62.29 – $173.25 | 11 |
| MRI lower extremity other than joint without contrast (both sides) CPT 73718 | $386.37 | $715.50 | $52.16 – $143.25 | 11 |
| MRI lower extremity other than joint without & w/contrast (both sides) CPT 73720 | $614.79 | $1,138.50 | $83.22 – $227.25 | 11 |
| MRI orbit/face/neck without contrast CPT 70540 | $237.60 | $440.00 | $51.88 – $142.50 | 11 |
| MRI orbit/face/neck without & w/contrast CPT 70543 | $379.08 | $702.00 | $82.94 – $227.25 | 11 |
| MRI orbit fac&nck w IV cont CPT 70542 | $286.74 | $531.00 | $62.57 – $173.25 | 11 |
| MRI tmj CPT 70336 | $259.74 | $481.00 | $66.04 – $157.50 | 11 |
| MRI upper extremity other than joint without contrast (both sides) CPT 73218 | $240.30 | $445.00 | $52.73 – $144.00 | 11 |
| MRI upper extremity other than joint without & w/contrast (both sides) CPT 73220 | $380.16 | $704.00 | $83.50 – $228.00 | 11 |
| MRI upper extremity w/dye CPT 73219 | $286.74 | $531.00 | $62.86 – $174.00 | 11 |
| Multiple sleep latency test CPT 95805 | $145.26 | $269.00 | $57.22 – $182.16 | 11 |
| Myelography l-s spine CPT 72265 | $147.42 | $273.00 | $39.54 – $87.00 | 11 |
| Myelography via inj w/s&i 2+ regions CPT 62305 | $385.56 | $714.00 | $48.00 – $269.25 | 11 |
| Myelography via inj w/s&i cervical CPT 62302 | $374.76 | $694.00 | $48.00 – $262.50 | 11 |
| Myelography via inj w/s&i lumbosacral CPT 62304 | $369.36 | $684.00 | $48.00 – $258.75 | 11 |
| Myelography via inj w/s&i thoracic CPT 62303 | $375.84 | $696.00 | $48.00 – $262.50 | 11 |
| Myomectomy abdom method CPT 58140 | $1,936.17 | $3,585.50 | $785.36 – $2,019.00 | 11 |
| Myomectomy vag method CPT 58145 | $1,169.10 | $2,165.00 | $483.40 – $1,218.00 | 11 |
| Nalbuphine 10 mg/ml injection solution HCPCS J2300 | $21.06 | $39.00 | $3.14 – $48.00 | 6 |
| Naloxone 0.4 mg/ml injection (wrapper) HCPCS J2312 | $75.91 | $140.58 | $84.22 – $84.22 | 1 |
A missing value means the hospital did not publish that price — it never means the price is zero. Real bills can add facility fees, supplies and professional fees; see our methodology.