CMS Price Transparency Data

Review of medical records for care

Facility: St Charles Medical Center Prineville

Billing Code: 90889 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90889
Insurance Median: $230
Cash Discount Price: $214
vs. Medicare Baseline: N/A Medicare

The contracted insurance negotiated median rate for a Review of medical records for care at St Charles Medical Center Prineville is $230. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $214. Compared to the federal Medicare reimbursement reference rate of N/A, this hospital’s rate is N/A the Medicare baseline. Located in 384 Se Combs Flat Road, Prineville, OR.

Cash / Self-Pay

$214

Average discount available for prompt cash payment at this facility.

Insurance Median

$230

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

N/A

Standard federal government reimbursement rate for this code.

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 (%)

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Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Aetna	$75 - $233	N/A
Ageright Advantage [142]	$75	N/A
Champ Va [700]	$75	N/A
Cigna	$75 - $168	N/A
Covid19 Hrsa Uninsured Testing And Treatment Fund	$75	N/A
Devoted Health Inc [145]	$75	N/A
Health Market Care Assured [134]	$75	N/A
Health Net Med Adv [135]	$75	N/A
Humana	$75	N/A
Indian Health [704]	$75	N/A
Kaiser Permanente Med Adv [136]	$75	N/A
Law Enforcement [701]	$75 - $133	N/A
Medicare (plans)	$75 - $87	N/A
Samaritan Health Plan Med Adv [141]	$75	N/A
Unicare [133]	$75	N/A
UnitedHealthcare	$75 - $247	N/A
Veterans [706]	$75	N/A
Wellcare [132]	$75	N/A
Blue Cross Blue Shield	$82	N/A
Tricare	$82	N/A
Advanced Health [534]	$94	N/A
Allcare Health Plan [538]	$94	N/A
Cascade Health Alliance [532]	$94	N/A
Columbia Pacific Coordinated Care Llc [539]	$94	N/A
Health Share Care Oregon [526]	$94	N/A
Health Share Kaiser [543]	$94	N/A
Health Share Ohsu Ohp [552]	$94	N/A
Health Share Providence [548]	$94	N/A
Health Share [537]	$94	N/A
Intercommunity Health [530]	$94	N/A
Jackson Care Connect [542]	$94	N/A
Medicaid / KanCare	$94	N/A
Primary Health Of Jospehine County Llc [547]	$94	N/A
Umpqua Health [533]	$94	N/A
Willamette Valley Community Health [536]	$94	N/A
Yamhill County Coordinated Care Org [550]	$94	N/A
Pacificsource [345]	$107 - $146	N/A
Us Benefits [326]	$168	N/A
Providence Health Plan [347]	$187 - $234	N/A
Rocky Mountain Administrators [405]	$214	N/A
Rx Internal [4100003]	$219	N/A
Moda [310]	$230	N/A
First Choice Health [317]	$232	N/A
Kaiser Permanente [334]	$232	N/A
Samaritan [376]	$232	N/A
Meritain Health [300]	$233	N/A
Health Net [340]	$251	N/A
Administrative Concepts Inc [402]	$262	N/A
First Health [339]	$262	N/A
Manhattan Life Insurance Company [379]	$262	N/A
Philadelphia American Life Insurance Company [395]	$262	N/A
Planned Administrators Inc [375]	$262	N/A
Auto Allstate Insurance [602]	$267	N/A
Auto American Family Insurance [603]	$267	N/A
Auto Country Insurance Claims [604]	$267	N/A
Auto Dairyland Insurance [617]	$267	N/A
Auto Farmers [605]	$267	N/A
Auto Geico Claims Oregon [606]	$267	N/A
Auto Hartford [612]	$267	N/A
Auto Liberty Mutual Auto Ins [613]	$267	N/A
Auto Mutual Of Enumclaw [610]	$267	N/A
Auto Nationwide Allied Insuranc [601]	$267	N/A
Auto Oregon Mutual [614]	$267	N/A
Auto Progressive [608]	$267	N/A
Auto Safeco Concentra [600]	$267	N/A
Auto State Farm Claims [609]	$267	N/A
Auto Sublimity Insurance [616]	$267	N/A
Auto Travelers Insurance [615]	$267	N/A
Auto Usaa [611]	$267	N/A
Generic Auto [649]	$267	N/A
Generic Workers Comp [699]	$267	N/A
Otj Broadspire Services [670]	$267	N/A
Otj Ccmsi [618]	$267	N/A
Otj Chartis Claims [650]	$267	N/A
Otj City County Ins Services [662]	$267	N/A
Otj Corvel [676]	$267	N/A
Otj Esis West Wc Claims [653]	$267	N/A
Otj Gallagher Bassett [654]	$267	N/A
Otj Hartford [655]	$267	N/A
Otj Intermountain Claims Inc [666]	$267	N/A
Otj Liberty Mutual Wausau Underwriters [671]	$267	N/A
Otj Penser No American [663]	$267	N/A
Otj Pinnacle Risk Mgmt [661]	$267	N/A
Otj Saif [667]	$267	N/A
Otj Sedgwick Cms [660]	$267	N/A
Otj Sedgwick [668]	$267	N/A
Otj Travelers Insurance [672]	$267	N/A
Otj Tristar [673]	$267	N/A

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 $214.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 90889.

Insurance In-Network Protection Plan

Contact your insurance company to confirm St Charles Medical Center Prineville is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 90889.
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.