CMS Price Transparency Data

CT scan, chest (no contrast)

Facility: St Charles Medical Center Prineville

Billing Code: 71250 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 71250
  • Insurance Median: $653
  • Cash Discount Price: $1,867
  • vs. Medicare Baseline: 6.11x Medicare
The contracted insurance negotiated median rate for a CT scan, chest (no contrast) at St Charles Medical Center Prineville is $653. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,867. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 6.11x the Medicare baseline. Located in 384 Se Combs Flat Road, Prineville, OR.
Cash / Self-Pay
$1,867

Average discount available for prompt cash payment at this facility.

Insurance Median
$653

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate
$106.81

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $106.81 (100%)
Cash / Self-Pay: $1,867 (1748%)
Insurance Median: $653 (611%)
Cash: $1,867 (1748% of Medicare)
Ins. Median: $653 (611% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $106.81 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 611% of the Medicare baseline (a markup of 511%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash 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
Pacificsource Community Solutions [525] $103 - $114 96%
Medicaid / KanCare $108 - $817 101%
Otj Dept Of Labor Federal Emp [652] $156 146%
Otj Us Department Of Labor [669] $156 146%
Auto Allstate Insurance [602] $194 182%
Auto American Family Insurance [603] $194 182%
Auto Country Insurance Claims [604] $194 182%
Auto Dairyland Insurance [617] $194 182%
Auto Farmers [605] $194 182%
Auto Geico Claims Oregon [606] $194 182%
Auto Hartford [612] $194 182%
Auto Liberty Mutual Auto Ins [613] $194 182%
Auto Mutual Of Enumclaw [610] $194 182%
Auto Nationwide Allied Insuranc [601] $194 182%
Auto Oregon Mutual [614] $194 182%
Auto Progressive [608] $194 182%
Auto Safeco Concentra [600] $194 182%
Auto State Farm Claims [609] $194 182%
Auto Sublimity Insurance [616] $194 182%
Auto Travelers Insurance [615] $194 182%
Auto Usaa [611] $194 182%
Generic Auto [649] $194 182%
Generic Workers Comp [699] $194 182%
Otj Broadspire Services [670] $194 182%
Otj Ccmsi [618] $194 182%
Otj Chartis Claims [650] $194 182%
Otj City County Ins Services [662] $194 182%
Otj Corvel [676] $194 182%
Otj Esis West Wc Claims [653] $194 182%
Otj Gallagher Bassett [654] $194 182%
Otj Hartford [655] $194 182%
Otj Intermountain Claims Inc [666] $194 182%
Otj Liberty Mutual Wausau Underwriters [671] $194 182%
Otj Penser No American [663] $194 182%
Otj Pinnacle Risk Mgmt [661] $194 182%
Otj Saif [667] $194 182%
Otj Sedgwick Cms [660] $194 182%
Otj Sedgwick [668] $194 182%
Otj Travelers Insurance [672] $194 182%
Otj Tristar [673] $194 182%
Kaiser Permanente [334] $230 - $2,021 215%
Moda [310] $249 - $2,007 233%
Providence Health Plan [347] $249 - $2,042 233%
Blue Cross Blue Shield $325 - $719 304%
Bridgespan [342] $325 304%
Asuris Northwest Health [202] $383 359%
Healthcare Management Admin [201] $383 359%
Regence Group Administrators [203] $383 359%
Aetna $653 - $2,030 611%
Ageright Advantage [142] $653 611%
Champ Va [700] $653 611%
Cigna $653 - $1,470 611%
Covid19 Hrsa Uninsured Testing And Treatment Fund $653 611%
Devoted Health Inc [145] $653 611%
Health Market Care Assured [134] $653 611%
Health Net Med Adv [135] $653 611%
Humana $653 611%
Indian Health [704] $653 611%
Kaiser Permanente Med Adv [136] $653 611%
Law Enforcement [701] $653 - $1,158 611%
Medicare (plans) $653 - $758 611%
Samaritan Health Plan Med Adv [141] $653 611%
Unicare [133] $653 611%
UnitedHealthcare $653 - $2,157 611%
Veterans [706] $653 611%
Wellcare [132] $653 611%
Tricare $712 667%
Advanced Health [534] $817 765%
Allcare Health Plan [538] $817 765%
Cascade Health Alliance [532] $817 765%
Columbia Pacific Coordinated Care Llc [539] $817 765%
Health Share Care Oregon [526] $817 765%
Health Share Kaiser [543] $817 765%
Health Share Ohsu Ohp [552] $817 765%
Health Share Providence [548] $817 765%
Health Share [537] $817 765%
Intercommunity Health [530] $817 765%
Jackson Care Connect [542] $817 765%
Primary Health Of Jospehine County Llc [547] $817 765%
Umpqua Health [533] $817 765%
Willamette Valley Community Health [536] $817 765%
Yamhill County Coordinated Care Org [550] $817 765%
Pacificsource [345] $933 - $1,277 874%
Us Benefits [326] $1,470 1376%
Rocky Mountain Administrators [405] $1,867 1748%
Rx Internal [4100003] $1,907 1785%
First Choice Health [317] $2,021 1892%
Samaritan [376] $2,021 1892%
Meritain Health [300] $2,030 1901%
Health Net [340] $2,194 2054%
Administrative Concepts Inc [402] $2,287 2141%
First Health [339] $2,287 2141%
Manhattan Life Insurance Company [379] $2,287 2141%
Philadelphia American Life Insurance Company [395] $2,287 2141%
Planned Administrators Inc [375] $2,287 2141%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 384 Se Combs Flat Road, Prineville, OR 97754
  • CMS Rating: ★★★☆☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Critical Access Hospitals