CMS Price Transparency Data
Office visit, established patient (20-29 min)
Facility: St Charles Madras
Billing Code: 99213 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 99213
- Insurance Median: $197
- Cash Discount Price: $245
- vs. Medicare Baseline: 2.07x Medicare
The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at St Charles Madras is $197. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $245. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 2.07x the Medicare baseline. Located in 470 Ne A Street, Madras, OR.
Cash / Self-Pay
$245
Average discount available for prompt cash payment at this facility.
Insurance Median
$197
Median negotiated contract rate across all mapped commercial carriers.
Medicare Reference Rate
$95.19
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. Medicare
Medicare Reference Baseline: $95.19 (100%)
Cash / Self-Pay: $245 (257%)
Insurance Median: $197 (207%)
Cash: $245 (257% of Medicare)
Ins. Median: $197 (207% of Medicare)
Understanding this gauge: We use the federal Medicare rate of $95.19 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 207% of the Medicare baseline (a markup of 107%). 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] | $24 - $146 | 25% |
| Advanced Health [534] | $33 - $578 | 35% |
| Allcare Health Plan [538] | $33 - $578 | 35% |
| Cascade Health Alliance [532] | $33 - $578 | 35% |
| Columbia Pacific Coordinated Care Llc [539] | $33 - $578 | 35% |
| Health Share Care Oregon [526] | $33 - $578 | 35% |
| Health Share Kaiser [543] | $33 - $578 | 35% |
| Health Share Ohsu Ohp [552] | $33 - $578 | 35% |
| Health Share Providence [548] | $33 - $578 | 35% |
| Health Share [537] | $33 - $578 | 35% |
| Intercommunity Health [530] | $33 - $578 | 35% |
| Jackson Care Connect [542] | $33 - $578 | 35% |
| Medicaid / KanCare | $33 - $578 | 35% |
| Primary Health Of Jospehine County Llc [547] | $33 - $578 | 35% |
| Umpqua Health [533] | $33 - $578 | 35% |
| Willamette Valley Community Health [536] | $33 - $578 | 35% |
| Yamhill County Coordinated Care Org [550] | $33 - $578 | 35% |
| Law Enforcement [701] | $39 - $699 | 41% |
| Aetna | $47 - $1,227 | 49% |
| Ageright Advantage [142] | $47 - $338 | 49% |
| Champ Va [700] | $47 - $338 | 49% |
| Cigna | $47 - $338 | 49% |
| Covid19 Hrsa Uninsured Testing And Treatment Fund | $47 - $338 | 49% |
| Devoted Health Inc [145] | $47 - $338 | 49% |
| Health Market Care Assured [134] | $47 - $338 | 49% |
| Health Net Med Adv [135] | $47 - $338 | 49% |
| Humana | $47 - $338 | 49% |
| Indian Health [704] | $47 - $338 | 49% |
| Kaiser Permanente Med Adv [136] | $47 - $338 | 49% |
| Medicare (plans) | $47 - $393 | 49% |
| Samaritan Health Plan Med Adv [141] | $47 - $338 | 49% |
| Unicare [133] | $47 - $338 | 49% |
| UnitedHealthcare | $47 - $1,303 | 49% |
| Veterans [706] | $47 - $338 | 49% |
| Wellcare [132] | $47 - $338 | 49% |
| Us Benefits [326] | $50 | 53% |
| Blue Cross Blue Shield | $52 - $372 | 55% |
| Providence Health Plan [347] | $56 - $1,234 | 59% |
| Tricare | $62 - $440 | 65% |
| Rocky Mountain Administrators [405] | $64 - $1,128 | 67% |
| Rx Internal [4100003] | $65 - $1,152 | 68% |
| Moda [310] | $68 - $1,410 | 71% |
| First Choice Health [317] | $69 - $1,221 | 72% |
| Kaiser Permanente [334] | $69 - $1,221 | 72% |
| Meritain Health [300] | $69 - $1,227 | 72% |
| Samaritan [376] | $69 - $1,221 | 72% |
| Health Net [340] | $75 - $1,326 | 79% |
| Administrative Concepts Inc [402] | $78 - $1,382 | 82% |
| First Health [339] | $78 - $1,382 | 82% |
| Manhattan Life Insurance Company [379] | $78 - $1,382 | 82% |
| Philadelphia American Life Insurance Company [395] | $78 - $1,382 | 82% |
| Planned Administrators Inc [375] | $78 - $1,382 | 82% |
| Pacificsource [345] | $79 - $771 | 83% |
| Auto Allstate Insurance [602] | $150 - $1,410 | 158% |
| Auto American Family Insurance [603] | $150 - $1,410 | 158% |
| Auto Country Insurance Claims [604] | $150 - $1,410 | 158% |
| Auto Dairyland Insurance [617] | $150 - $1,410 | 158% |
| Auto Farmers [605] | $150 - $1,410 | 158% |
| Auto Geico Claims Oregon [606] | $150 - $1,410 | 158% |
| Auto Hartford [612] | $150 - $1,410 | 158% |
| Auto Liberty Mutual Auto Ins [613] | $150 - $1,410 | 158% |
| Auto Mutual Of Enumclaw [610] | $150 - $1,410 | 158% |
| Auto Nationwide Allied Insuranc [601] | $150 - $1,410 | 158% |
| Auto Oregon Mutual [614] | $150 - $1,410 | 158% |
| Auto Progressive [608] | $150 - $1,410 | 158% |
| Auto Safeco Concentra [600] | $150 - $1,410 | 158% |
| Auto State Farm Claims [609] | $150 - $1,410 | 158% |
| Auto Sublimity Insurance [616] | $150 - $1,410 | 158% |
| Auto Travelers Insurance [615] | $150 - $1,410 | 158% |
| Auto Usaa [611] | $150 - $1,410 | 158% |
| Generic Auto [649] | $150 - $1,410 | 158% |
| Generic Workers Comp [699] | $150 - $1,410 | 158% |
| Otj Broadspire Services [670] | $150 - $1,410 | 158% |
| Otj Ccmsi [618] | $150 - $1,410 | 158% |
| Otj Chartis Claims [650] | $150 - $1,410 | 158% |
| Otj City County Ins Services [662] | $150 - $1,410 | 158% |
| Otj Corvel [676] | $150 - $1,410 | 158% |
| Otj Esis West Wc Claims [653] | $150 - $1,410 | 158% |
| Otj Gallagher Bassett [654] | $150 - $1,410 | 158% |
| Otj Hartford [655] | $150 - $1,410 | 158% |
| Otj Intermountain Claims Inc [666] | $150 - $1,410 | 158% |
| Otj Liberty Mutual Wausau Underwriters [671] | $150 - $1,410 | 158% |
| Otj Penser No American [663] | $150 - $1,410 | 158% |
| Otj Pinnacle Risk Mgmt [661] | $150 - $1,410 | 158% |
| Otj Saif [667] | $150 - $1,410 | 158% |
| Otj Sedgwick Cms [660] | $150 - $1,410 | 158% |
| Otj Sedgwick [668] | $150 - $1,410 | 158% |
| Otj Travelers Insurance [672] | $150 - $1,410 | 158% |
| Otj Tristar [673] | $150 - $1,410 | 158% |