Biopsy of heart lining at Providence Mission Hospital - Mission Viejo
27700 Medical Center Rd, Mission Viejo, CA · Providence · · NPI 1003956913
$2,006.88
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.
$4,181.00
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.
$3,429.00 with Aetna vs $11,662.00 with Blue Cross — 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 |
|---|---|---|---|
| Aetna | Gatekeeper Hmo | $3,429.00 | ↑ +71% |
| Providence | Oscar All Commercial Plans | $3,451.89 | ↑ +72% |
| Aetna | Medicare Managed Care Plan | $4,061.05 | ↑ +102% |
| Blue Cross | Anthem Vivity City Of La Other Commercial Plan | $4,254.67 | ↑ +112% |
| Blue Cross | Anthem Vivity Non City Of La Other Commercial Plan | $4,791.97 | ↑ +139% |
| Blue Shield | Epn Exchange | $5,171.00 | ↑ +158% |
| Blue Shield | Tandem Ppo | $6,425.00 | ↑ +220% |
| Blue Shield | Hmo/Ppo | $7,143.00 | ↑ +256% |
| Healthnet | Ambetter Hmo | $7,512.94 | ↑ +274% |
| Unitedhealthcare | Select/Navigate Hmo | $7,883.00 | ↑ +293% |
| Unitedhealthcare | All Commercial Plans | $8,704.00 | ↑ +334% |
| Blue Cross | Anthem Non-Mcs (Ind1, Ncx1, Ncx3) All Commercial Plans | $9,718.00 | ↑ +384% |
| Healthnet | Hmo/Pos/Ppo | $9,990.00 | ↑ +398% |
| Blue Cross | Anthem Mcs (Indx) All Commercial Plans | $11,662.00 | ↑ +481% |
Visitor-reported prices
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Biopsy of heart lining at other California hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| Arroyo Grande Hospital | Santa Maria | $2,223.46 | $272.83 – $5,091.10 |
| French Hospital | San Luis Obispo | $1,973.72 | $272.83 – $4,934.30 |
| Bakersfield Memorial Hospital | Bakersfield | $2,251.55 | $272.83 – $4,846.65 |
| St. Joseph's Medical Center Stockton | Stockton | $1,803.69 | $272.83 – $5,153.40 |
| Santa Rosa Memorial Hospital | Santa Rosa | $3,796.44 | $2,238.00 – $11,377.00 |
| Mercy Medical Center Merced | Merced | $3,159.53 | $272.83 – $6,073.65 |
| Dominican Hospital | Santa Cruz | $1,465.65 | $272.83 – $10,194.41 |
| St. Mary Medical Center | Long Beach | $1,976.28 | $272.83 – $6,398.74 |