CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: St Charles Madras

Billing Code: 99213 (CPT)

The BaseRate · fair price high confidence

A fair price for this

$140

about 1.5× the $95 Medicare rate · typically $93–$149

modeled estimate · not a bill or quote

What this hospital charges insurers

$150

About the fair price

about $10 over the fair price · 1.6× Medicare

Medicare pays $95 Fair price $140 This hospital $150 Cash price $245 Hospital's list price $306

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 $150

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 $140 (about 1.5× the $95 Medicare rate). St Charles Madras charges insurers about $150, or about $245 in cash — about the fair price. Located in Madras, 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	$47 - $1,303	49%
Blue Cross Blue Shieldmajor	$52 - $372	55%
Aetnamajor	$47 - $1,227	49%
Cignamajor	$47 - $338	49%
Humanamajor	$47 - $338	49%
Kaiser Permanentemajor	$33 - $1,221	35%
Devoted Health	$47 - $338	49%
Health Net	$47 - $1,326	49%
Moda Health	$68 - $1,410	71%
PacificSource	$24 - $771	25%
Providence Health Plan	$56 - $1,234	59%
UniCare	$47 - $338	49%
WellCare	$47 - $338	49%
+ 61 smaller / regional plans	$33 - $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 245), 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 Madras 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 Madras

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

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