Optx prox humrl fx w/int fix at Mercy Medical Center Merced
333 Mercy Ave., Merced, CA · CommonSpirit Health · · NPI 1518018191
not published by hospital
Cash price Discounted cash price What a hospital charges a self-pay patient who pays directly, without going through insurance — usually well below the gross charge. Example: A CT scan has a $3,200 gross charge but an $850 discounted cash price. Ask for it by name when scheduling — hospitals don't always advertise it up front.
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What you pay up front if you don't use insurance.
not published by hospital
Gross charge Gross charge (chargemaster price) The hospital's full, undiscounted list price — pulled from its internal "chargemaster" price list. Almost no one actually pays this. Example: A chest X-ray has a gross charge of $1,450. The same hospital's discounted cash price for the same X-ray is $180 — the gross charge mostly anchors negotiations, not what patients pay.
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The hospital's undiscounted list price — almost no one pays this.
$580.60 with Kaiser vs $34,751.00 with Health Net — same scan, same building. Share
Negotiated rates by payer
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Negotiated rate
The price a specific insurance plan agreed to pay the hospital for a service — it varies by insurer, and even by plan within the same insurer.
Example: The same knee MRI has a negotiated rate of $904 with one insurer's PPO plan and $1,509 with another's — identical hospital, identical scan.
Full explanation →
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Negotiated rate
The price a specific insurance plan agreed to pay the hospital for a service — it varies by insurer, and even by plan within the same insurer.
Example: The same knee MRI has a negotiated rate of $904 with one insurer's PPO plan and $1,509 with another's — identical hospital, identical scan.
Full explanation →Payer ?Payer The insurance company footing the bill — Aetna, UnitedHealthcare, Medicare, and so on. Example: "Blue Cross Blue Shield" is the payer. Its negotiated rate for an MRI might be $904, while a different payer's negotiated rate for the same scan is $1,509. Full explanation → |
Plan ?Plan The specific product an insurer sells — e.g. "Blue Cross PPO 500" — which sets your deductible, coinsurance and negotiated rates. Example: Two people both insured by Aetna can owe very different amounts for the same MRI: $50 with an HMO plan's flat copay, or the full $1,200 toward a high-deductible PPO plan's unmet deductible. Full explanation → |
Negotiated rate | vs. cash |
|---|---|---|---|
| Kaiser | Medicaid|< 21 | $580.60 | — |
| Kaiser | Medicaid|> 21 | $580.60 | — |
| Molina | Medicaid|> 21 | $580.60 | — |
| Health Plan of San Joaquin | Medicaid|< 21 | $580.60 | — |
| Inland Empire Health Plan | Medicaid|< 21 | $580.60 | — |
| California Health & Wellness | Medicaid|> 21 | $580.60 | — |
| California Health & Wellness | Medicaid|< 21 | $580.60 | — |
| Kern Health System | Medicaid|> 21 | $580.60 | — |
| Kern Health System | Medicaid|< 21 | $580.60 | — |
| Partnership Health Plan | Medicaid|> 21 | $580.60 | — |
| Partnership Health Plan | Medicaid|< 21 | $580.60 | — |
| Inland Empire Health Plan | Medicaid|> 21 | $580.60 | — |
| Health Plan of San Joaquin | Medicaid|> 21 | $580.60 | — |
| Molina | Medicaid|< 21 | $580.60 | — |
| BCBS - Anthem | Medicaid|> 21 | $834.61 | — |
| BCBS - Anthem | Medicaid|< 21 | $834.61 | — |
| Central California Alliance for Health | Medicaid|All Plans | $915.22 | — |
| Health Net | Medicaid|All Plans | $1,976.88 | — |
| BCBS - Anthem | Commercial|Exchange | $9,887.00 | — |
| Aetna | Commercial|HMO | $10,057.00 | — |
| Aetna | Commercial|All Other Plans | $10,057.00 | — |
| Aetna | Commercial|PPO | $10,057.00 | — |
| BCBS - Anthem | Commercial|All Other Plans | $13,009.00 | — |
| Kaiser | Medicare|All Plans | $16,348.58 | — |
| Aetna | Medicare|All Plans | $16,348.58 | — |
| United | Medicare|All Plans | $16,348.58 | — |
| Health Net | Medicare|All Plans | $16,348.58 | — |
| Humana | Medicare|All Plans | $16,348.58 | — |
| BCBS - Anthem | Medicare|All Plans | $16,348.58 | — |
| Blue Shield CA | Medicare|All Plans | $16,348.58 | — |
| Scan Health Plan | Medicare|All Plans | $16,348.58 | — |
| LA Care | Medicare|All Plans | $16,348.58 | — |
| BCBS - Anthem | Commercial|MCS | $20,554.00 | — |
| Health Net | Commercial|Care Product | $30,527.00 | — |
| Health Net | Commercial|FFS | $34,751.00 | — |
| Healthsmart | Commercial|All Plans | not published by hospital | — |
| United | Commercial|Non-Options PPO | not published by hospital | — |
| United | Commercial|Options PPO | not published by hospital | — |
| United | Commercial|HMO | not published by hospital | — |
| United | Commercial|All Other Plans | not published by hospital | — |
| Kaiser | Commercial|All Plans | not published by hospital | — |
| Cigna | Commercial|PPO | not published by hospital | — |
| First Health | Commercial|All Plans | not published by hospital | — |
| Cigna | Commercial|All Other Plans | not published by hospital | — |
| MultiPlan | Commercial|All Plans | not published by hospital | — |
Visitor-reported prices
Comments
Optx prox humrl fx w/int fix at other California hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| Petaluma Valley Hospital | Petaluma | $26,561.82 | $3,632.00 – $17,654.63 |
| Mark Twain Medical Center | San Andreas | $1,537.80 | $580.60 – $2,262.82 |
| Queen of The Valley Medical Center | Napa | $28,751.76 | $9,256.00 – $62,607.00 |
| Providence St Joseph Hospital Eureka | Eureka | $25,677.48 | $11,036.00 – $62,607.00 |
| Healdsburg Hospital | Healdsburg | $7,540.86 | $4,417.00 – $17,298.12 |
| Redwood Memorial Hospital | Fortuna | $16,636.71 | $11,059.00 – $62,607.00 |
| Santa Rosa Memorial Hospital | Santa Rosa | $28,431.48 | $4,233.00 – $18,229.15 |
| Providence Mission Hospital - Mission Viejo | Mission Viejo | $8,412.96 | $9,779.00 – $30,548.47 |