Biopsy of lip 40490 at Providence Saint John's Health Center
2121 Santa Monica Blvd, Santa Monica, CA · Providence · · NPI 1124026273
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.
$304.63 with Aetna vs $4,239.46 with Blue Shield — 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 | Medicare Managed Care Plan | $304.63 | — |
| Humana | Choicecare Medicare Managed Care Plan | $310.72 | — |
| Blue Cross | Anthem Vivity City Of La Other Commercial Plan | $319.15 | — |
| Central Health Plan | Medicare Managed Care Plan | $335.09 | — |
| Blue Cross | Anthem Vivity Non City Of La Other Commercial Plan | $359.46 | — |
| La Care Health Plan | Covered Ca Exchange | $396.02 | — |
| Blue Shield | Epn/Ifp Benefit Exchange | $537.23 | — |
| Healthnet | Ambetter Hmo | $563.56 | — |
| Healthnet | Blue And Gold Other Commercial Plan | $601.00 | — |
| Healthnet | Ambetter Ppo | $651.91 | — |
| Healthnet | All Commercial Plans | $970.00 | — |
| Blue Shield | Medicare Managed Care Plan | $1,142.09 | — |
| Unitedhealthcare | Select/Navigate Hmo | $1,487.00 | — |
| Unitedhealthcare | All Commercial Plans | $1,687.00 | — |
| Blue Shield | Tandem Ppo/Blue High Performance Ppo/Epo | $3,816.60 | — |
| Blue Cross | All Commercial Plans | $4,005.00 | — |
| Blue Shield | Ppo/Epo | $4,239.46 | — |
| Blue Shield | Hmo | $4,239.46 | — |
Visitor-reported prices
Comments
Biopsy of lip 40490 at other California hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| St. John's Camarillo Hospital | Camarillo | not published | $68.31 – $521.66 |
| Petaluma Valley Hospital | Petaluma | not published | $319.18 – $1,921.00 |
| Arroyo Grande Hospital | Santa Maria | not published | $55.54 – $295.06 |
| Mark Twain Medical Center | San Andreas | not published | $55.54 – $55.54 |
| French Hospital | San Luis Obispo | not published | $55.54 – $295.06 |
| Mercy Hospitals – Bakersfield | Bakersfield | not published | $55.54 – $295.06 |
| Bakersfield Memorial Hospital | Bakersfield | not published | $55.54 – $295.06 |
| Queen of The Valley Medical Center | Napa | not published | $336.29 – $6,200.00 |