CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: St Charles Medical Center Prineville

Billing Code: 99213 (CPT)

The BaseRate · fair price high confidence

A fair price for this

$167

about 1.8× the $95 Medicare rate · typically $100–$258

modeled estimate · not a bill or quote

What this hospital charges insurers

$141

Below the fair price — a good deal

about $26 under the fair price · 1.5× Medicare

Medicare pays $95 Fair price $167 This hospital $141 Cash price $369 Hospital's list price $462

How we calculate the fair BaseRate →

How this hospital compares to other OR hospitals

Highest price of the 9 OR hospitals we have prices for — worth calling around.

Cheapest $48 Priciest $141

Black dot = this hospital, among the 9 OR hospitals with a price for this procedure. Full list below.

A fair price for a Office visit, established patient (20-29 min) is about $167 (about 1.8× the $95 Medicare rate). St Charles Medical Center Prineville charges insurers about $141, or about $369 in cash — below the fair price — a good deal. Located in Prineville, OR.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

6 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Cigna✓ Humana✓ Kaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$86 - $1,303	90%
Blue Cross Blue Shieldmajor	$94 - $434	99%
Aetnamajor	$86 - $1,227	90%
Cignamajor	$86 - $395	90%
Humanamajor	$86 - $395	90%
Kaiser Permanentemajor	$86 - $1,221	90%
Devoted Health	$86 - $395	90%
Health Net	$86 - $1,326	90%
Moda Health	$306 - $1,410	321%
PacificSource	$122 - $771	128%
Providence Health Plan	$214 - $1,234	225%
UniCare	$86 - $395	90%
WellCare	$86 - $395	90%
+ 60 smaller / regional plans	$86 - $1,410

Government programs also on file: Medicare, Medicaid, Military & VA.

Excludes 5 rental-network / third-party entries (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price (about 369), before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the CPT code on your bill matches exactly: 99213.

Insurance Before you use insurance

Call your insurance company to confirm St Charles Medical Center Prineville is in-network.
Ask your insurer whether prior approval is required for CPT code 99213.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at St Charles Medical Center Prineville

Compare: Office visit, established patient (20-29 min) at other OR hospitals

Insurance negotiated median for the same procedure, sorted lowest first.