How many shoppable procedure prices are published for Providence Mission Hospital?

Providence Mission Hospital in Mission Viejo, CA currently has 120 standardized procedure price records indexed from its public 45 CFR § 180 machine-readable file.

How do Providence Mission Hospital's commercial prices compare to the fair BaseRate?

Across scored shoppable procedures, Providence Mission Hospital's median negotiated commercial rate is 1.4× the regionally adjusted fair BaseRate benchmark.

What is Providence Mission Hospital's CMS Care Compare overall star rating?

CMS Care Compare assigns Providence Mission Hospital an overall hospital quality rating of 5 out of 5 stars based on public federal clinical and patient-experience measures.

Hospital Profile Acute Care Hospital Voluntary non-profit - Private 303 Beds · rural Updated: 2026-04-01

Providence Mission Hospital

27700 Medical Center Rd, Mission Viejo, CA 92691 · 120 Priced Procedures · 73% Patient Recommendation

CMS Overall Rating 5 / 5 Stars

Above Fair Market · Negotiate

1.42×vs. Fair Market Price

Typical commercial prices here are +42% above the fair benchmark (1.42×) even after accounting for local nurse/doctor wages and patient complexity.

79/100 · Corroborated

79/100Self-Pay Cash Beats Insurance 25% of the Time

File Completeness66

Price Logic85

Peer Alignment70

Clean Billing75

Real Cash Discount100

High-Markup · Check Safety

3-Star CMS clinical quality rating paired with 1.42× fair market pricing.

Behavioral Pricing FingerprintUpper-Quartile Spread · +34% Tail Jump

Wide Procedure Spread · Upper-Quartile Skew Pricer

Providence Mission Hospital prices routine shoppable procedures at 2.0× Medicare (median 1.40× Fair BaseRate) while upper-quartile commercial rates jump +34% to 1.87× Fair BaseRate. Self-pay cash discounts and comparing specific CPT procedure codes before scheduling yield the strongest savings.

#190 of 240 in CA · 78th State Percentile#2,496 of 3,385 in U.S. · 73rd National Percentile

Advantage

Where They're Good (Patient & Payer Edge)

Bottom-quartile procedures (Q25) price at 1.18× the peer BaseRate benchmark
Self-pay cash beats commercial insurance on 25% of shoppable procedures (99/100 Cash Honesty)
5-Star CMS clinical rating with 73% patient recommendation (68/100 safety score)
IRS 501(c)(3) charity care provides free care up to 200% FPL and discounted care up to 400% FPL (17.9% AGB cap)

Watchout

Where You Can Get Burned (Markup Traps)

Even at low-cost facilities (1.42× Fair BaseRate), out-of-network or unnegotiated chargemaster bills can exceed commercial medians — confirm in-network status or request a self-pay cash quote up front.
Commercial insurance median sits at 1.40× Fair BaseRate (2.0× Medicare), so insured patients should always compare the self-pay cash price before paying.
Upper-quartile procedures (Q75 1.87×) jump +34% above the median procedure ratio (Q50 1.40×)
Unnegotiated chargemaster list prices average 12.0× Medicare (14¢ true HCRIS cost per $1 gross)

Front-Door ShoppableElective / Imaging

2.0× Medicare

Pre-scheduled outpatient procedures where patients can comparison-shop.

Back-Door Captive & ER0.90× Divergence

1.8× Medicare

Emergency, inpatient DRG, lab, and specialty drug lines billed after admission.

Quantile Tail Spread+34% Upper Tail

Q25 1.18× · Q50 1.40× · Q75 1.87×

Detects median-gaming when upper-quartile codes spike above the p50 median.

Select any lens to inspect department markups, federal cost accounting, or insurer discounts.

Department & Integrity Multiples (vs. CMS Medicare Cost Anchor) Green ≤1.3× · Teal 1.3–1.8× · Amber 1.8–2.5× · Rose >2.5×

Front-Door Shoppable CareFront-Door Shoppable

2.0× MedicareGood

Outpatient Surgery & ORBack-Door Captive

0.6× MedicareGood

Diagnostic Imaging (CT/MRI)Front-Door Shoppable

3.1× MedicareFair

Back-Door Captive ER VisitsBack-Door Captive

12.1× MedicareWatchout

Inpatient Lab & PathologyBack-Door Captive

2.5× MedicareFair

Specialty & Infusion Drugs (J-Codes)Back-Door Captive

1.7× MedicareGood

Self-Pay Cash Honesty & 501(r)Integrity & Outcomes

25% Cash Edge · 99/100Good

CMS Clinical Safety & Star ValueIntegrity & Outcomes

5 CMS · 68/100Fair

Procedure Prices at Providence Mission Hospital

High-impact clinical procedures (MRIs, surgeries, inpatient stays, visits) are prioritized first. Use the category pills or search bar to filter all 120 published procedures.

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Audit a Bill & 501(r) Cap ↓

Procedure & Billing Code	Self-Pay Cash	This Hospital	Fair BaseRate	vs. Fair
Spinal fusion, single level (inpatient stay) MS-DRG Code: `451`	—	$31,316	$30,775	1.0×
Sepsis treatment (inpatient stay) MS-DRG Code: `871`	—	$19,052	$19,087	1.0×
Hip or knee replacement (inpatient stay) MS-DRG Code: `470`	—	$18,923	$19,432	1.0×
Heart stent placement (inpatient stay) MS-DRG Code: `322`	—	$17,343	$17,936	1.0×
Total knee replacement CPT Code: `27447`	—	$16,003	$13,523	1.2×
Total hip replacement CPT Code: `27130`	—	$15,236	$13,413	1.1×
Gallbladder removal (laparoscopic) CPT Code: `47562`	—	$13,842	$6,109	unverified
C-section delivery (full package) CPT Code: `59510`	—	$10,925	$2,975	3.7×
Vaginal delivery (full package) CPT Code: `59400`	—	$9,559	$2,680	3.6×
Knee arthroscopy with meniscus repair CPT Code: `29881`	—	$9,242	$3,372	unverified
Breast lump removal CPT Code: `19120`	—	$8,410	$3,875	2.2×
Bunion correction surgery CPT Code: `28296`	$4,885	$8,306	$3,446	2.4×
Digestive disorders treatment (inpatient stay) MS-DRG Code: `392`	—	$7,979	$8,223	1.0×
Cataract surgery with lens implant CPT Code: `66984`	—	$5,743	$2,540	2.3×
Colonoscopy with biopsy CPT Code: `45380`	—	$3,548	$1,256	2.8×
Inguinal hernia repair CPT Code: `49505`	$2,280	$2,280	$3,629	0.6×
Injection procedure for pain management HCPCS Code: `G0260`	—	$1,939	$855	2.3×
Trauma team activation HCPCS Code: `G0390`	$20,723	$1,796	$1,453	1.2×
Sleep study (overnight, in lab) CPT Code: `95810`	$1,383	$1,502	$1,021	1.5×
Blood transfusion CPT Code: `36430`	$898	$1,455	$498	unverified
Upper endoscopy with biopsy CPT Code: `43239`	$1,352	$1,352	$987	unverified
Colonoscopy (diagnostic) CPT Code: `45378`	$1,204	$1,204	$981	unverified
Echocardiogram (heart ultrasound) CPT Code: `93306`	$1,972	$989	$583	1.7×
Psychological testing by technician CPT Code: `96138`	—	$870	$395	2.2×
CT scan, abdomen and pelvis (with contrast) CPT Code: `74177`	$2,167	$611	$448	1.4×
MRI, brain (with and without contrast) CPT Code: `70553`	$4,021	$611	$511	1.2×
Ultrasound, leg veins (duplex) CPT Code: `93970`	$1,110	$568	$272	2.1×
Rabies immune globulin HCPCS Code: `90375`	$3,211	$416	$322	1.3×
CT scan, abdomen and pelvis (no contrast) CPT Code: `74176`	$1,939	$373	$303	1.2×
MRI, lower back (no contrast) CPT Code: `72148`	$2,206	$373	$338	1.1×
MRI, brain (no contrast) CPT Code: `70551`	$2,042	$373	$343	1.1×
MRI, knee or other leg joint CPT Code: `73721`	$2,222	$373	$369	1.0×
Electrocardiogram (ECG/EKG) CPT Code: `93000`	—	$368	$25	unverified
Breathing treatment (nebulizer) CPT Code: `94640`	$432	$282	$201	1.4×
Neurobehavioral status check CPT Code: `96116`	$160	$291	$231	1.3×
CT scan, head (with contrast) CPT Code: `70460`	$1,399	$292	$242	1.2×
CT scan, head (with and without contrast) CPT Code: `70470`	$1,438	$292	$258	1.1×
Psychological testing evaluation CPT Code: `96136`	—	$259	$128	2.0×
Hepatitis B immune globulin HCPCS Code: `90371`	$1,090	$234	$151	1.5×
Psychotherapy session (45 minutes) CPT Code: `90834`	$213	$239	$166	1.4×
Family therapy session CPT Code: `90847`	$213	$239	$173	1.4×
Psychotherapy session (60 minutes) CPT Code: `90837`	$281	$239	$181	1.3×
Psychiatric evaluation (first visit) CPT Code: `90791`	$159	$239	$185	1.3×
Diagnostic mammogram (both breasts) CPT Code: `77066`	$703	$208	$148	1.4×
Diagnostic procedure preparation HCPCS Code: `G0279`	$218	$219	$35	unverified
X-ray, lower back CPT Code: `72110`	$435	$179	$112	1.6×
X-ray, pelvis CPT Code: `72170`	$241	$169	$110	1.5×
Screening mammogram (both breasts) CPT Code: `77067`	$580	$181	$123	1.5×
Ultrasound, abdomen (limited) CPT Code: `76705`	$636	$179	$126	1.4×
Ultrasound, pelvis CPT Code: `76856`	$769	$179	$130	1.4×
Ultrasound, thyroid and neck CPT Code: `76536`	$665	$179	$132	1.4×
Ultrasound, abdomen (complete) CPT Code: `76700`	$911	$179	$134	1.3×
CT scan, head (no contrast) CPT Code: `70450`	$1,302	$179	$160	1.1×
CT scan, pelvis CPT Code: `72192`	$1,342	$179	$163	1.1×
CT scan, sinuses CPT Code: `70486`	$1,399	$179	$166	1.1×
CT scan, chest (no contrast) CPT Code: `71250`	$1,770	$179	$167	1.1×
CT scan, lower back (lumbar spine) CPT Code: `72131`	$1,651	$179	$168	1.1×
CT scan, neck (cervical spine) CPT Code: `72125`	$1,554	$179	$169	1.1×
X-ray, foot CPT Code: `73630`	$284	$130	$92	1.4×
X-ray, neck (cervical spine) CPT Code: `72040`	$251	$130	$93	1.4×
X-ray, hand CPT Code: `73130`	$435	$130	$93	1.4×
X-ray, hip CPT Code: `73502`	$517	$130	$93	1.4×
X-ray, ankle CPT Code: `73610`	$284	$130	$93	1.4×
X-ray, chest (single view) CPT Code: `71045`	$237	$128	$92	1.4×
X-ray, shoulder CPT Code: `73030`	$475	$128	$92	1.4×
X-ray, chest (two views) CPT Code: `71046`	$443	$128	$93	1.4×
Group therapy session CPT Code: `90853`	$197	$137	$100	1.4×
Electrocardiogram (EKG, tracing only) CPT Code: `93005`	$288	$90	$64	1.4×
Speech therapy (language evaluation) CPT Code: `92507`	$243	$81	$86	0.9×
Typhoid vaccine HCPCS Code: `90675`	$1,156	$456	$347	1.3×
Varicella (chickenpox) vaccine HCPCS Code: `90716`	$455	$294	$203	1.4×
Pneumococcal vaccine HCPCS Code: `90732`	$343	$201	$140	1.4×
MMR vaccine (measles, mumps, rubella) HCPCS Code: `90707`	$288	$160	$111	1.4×
Blood test, vitamin D CPT Code: `82306`	$59	$57	$31	1.8×
Blood antibody screen CPT Code: `86850`	$51	$69	$46	1.5×
DTaP vaccine (diphtheria, tetanus, pertussis) HCPCS Code: `90700`	$92	$56	$39	1.4×
Tdap vaccine (tetanus, diphtheria, pertussis) HCPCS Code: `90715`	$155	$74	$56	1.3×
Blood test, average blood sugar (A1c) CPT Code: `83036`	$27	$27	$10	2.7×
Hepatitis B vaccine HCPCS Code: `90744`	$65	$52	$37	1.4×
Flu vaccine injection HCPCS Code: `G0008`	—	$63	$48	1.3×
Pneumonia vaccine injection HCPCS Code: `G0009`	—	$63	$49	1.3×
Colorectal cancer screening HCPCS Code: `G0010`	—	$63	$49	1.3×
Orthotic fitting and training CPT Code: `97760`	$85	$52	$51	1.0×
Prosthetic fitting and training CPT Code: `97761`	—	$45	$45	1.0×
Hospital observation (per hour) HCPCS Code: `G0378`	$67	$67	$86	0.8×
Urinalysis (automated, with microscopy) CPT Code: `81001`	$92	$6	$3	2.0×
Blood test, calcium CPT Code: `82310`	$26	$10	$5	2.0×
Blood test, creatinine (kidney) CPT Code: `82565`	$41	$10	$5	2.0×
Blood test, glucose (blood sugar) CPT Code: `82947`	$60	$8	$4	2.0×
Blood test, potassium CPT Code: `84132`	$23	$10	$5	2.0×
Blood test, urea nitrogen (BUN, kidney) CPT Code: `84520`	$60	$8	$4	2.0×
Blood test, complete blood count (CBC) CPT Code: `85025`	$25	$16	$8	2.0×
Blood test, clotting time (PTT) CPT Code: `85730`	$22	$12	$6	2.0×
Blood test, cholesterol (lipid panel) CPT Code: `80061`	$29	$27	$14	1.9×
Blood test, comprehensive metabolic panel CPT Code: `80053`	$14	$21	$11	1.9×
Blood test, basic metabolic panel CPT Code: `80048`	$51	$17	$9	1.9×
Culture, bacterial CPT Code: `87070`	$75	$17	$9	1.9×
Blood test, amylase CPT Code: `82150`	$41	$13	$7	1.9×
Blood test, ferritin (iron stores) CPT Code: `82728`	$39	$26	$14	1.9×
Blood test, lipase CPT Code: `83690`	$58	$13	$7	1.9×
Blood test, magnesium CPT Code: `83735`	$25	$13	$7	1.9×
Blood test, PSA (prostate screen) CPT Code: `84153`	$38	$35	$19	1.8×
Culture, blood CPT Code: `87040`	$242	$20	$11	1.8×
Blood test, vitamin B12 CPT Code: `82607`	$57	$29	$16	1.8×
Electrical stimulation therapy HCPCS Code: `G0283`	$43	$14	$14	1.0×
Occupational therapy (self-care training) CPT Code: `97535`	$87	$36	$38	0.9×
Physical therapy (functional capacity test) CPT Code: `97750`	$92	$36	$38	0.9×
Blood test, sodium CPT Code: `84295`	$49	$9	$5	1.8×
Blood test, clotting time (PT/INR) CPT Code: `85610`	$27	$9	$5	1.8×
Hepatitis C antibody test CPT Code: `86803`	$58	$27	$15	1.8×
Blood test, liver function panel CPT Code: `80076`	$50	$16	$9	1.8×
Blood test, thyroid (TSH) CPT Code: `84443`	$54	$31	$18	1.7×
Flu vaccine (high dose) HCPCS Code: `90656`	—	$34	$25	1.4×
Occupational therapy (therapeutic activities) CPT Code: `97530`	$89	$39	$40	1.0×
Physical therapy (therapeutic exercise) CPT Code: `97110`	$92	$32	$35	0.9×
Physical therapy (neuromuscular re-education) CPT Code: `97112`	$103	$34	$38	0.9×
Blood test, hemoglobin CPT Code: `85018`	$35	$5	$3	1.7×
Speech therapy (group session) CPT Code: `92508`	$92	$27	$27	1.0×
Physical therapy (gait training) CPT Code: `97116`	$102	$30	$33	0.9×
Physical therapy (manual therapy) CPT Code: `97140`	$97	$29	$34	0.9×

Showing top 25 high-impact procedures of 120 total

Inline Bill X-Ray & 501(r) Calculator 501(c)(3) Nonprofit · Free Care ≤200% FPL · AGB Cap 17.9%

Audit a Bill or Quote at Providence Mission Hospital (Zero PHI Required)

CMS CCN: 050567

CPT 451

Select Procedure to Audit:

Fair BaseRate™ $30,775

Medicare Rate $23,504

Self-Pay Cash Request Quote

Insurer Median $31,316

1. Amount on Your Bill or Quote ($) Pre-filled with Providence Mission Hospital’s charged/list benchmark

2. Household Annual Income ($) Screened against 2026 HHS Federal Poverty Guidelines

3. Household Size (1–8) 2026 FPL: $15,650 + $5,500 per additional person

Step 1 · 501(r) Charity Care Check 501(r) AGB Cap: $13,468 (274% FPL)

Statutory 501(r) AGB Cap Limits Bill to $13,468

At 274% FPL (201%–400% FPL tier), 26 U.S.C. § 501(r)(5) caps FAP-eligible bills at Amounts Generally Billed (17.9% of gross = $13,468).

Step 2 · Cash vs. Insurance Arbitrage Request Prompt-Pay Quote

Compare Prompt-Pay Cash Rate Against Remaining Deductible

Ask Providence Mission Hospital's billing desk for their written 45 CFR § 180 discounted self-pay cash price and Good Faith Estimate under the No Surprises Act.

Step 3 · Fair BaseRate Target +$44,383 Above Fair BaseRate

Negotiate Toward $30,775 Fair BaseRate ($23,504 Medicare)

Your bill ($75,158) is $44,383 above the denoised Fair BaseRate ($30,775) and 3.2× the $23,504 Medicare rate.

1-Click Factual Dispute Summary: Copy a citation-backed benchmark memo (with CMS CCN, CPT code, Medicare reference, Fair BaseRate, and 26 U.S.C. § 501(r) calculations) to paste into patient-portal messages or billing appeals.

IRS Form 990 Schedule H & 26 U.S.C. § 501(r) 501(c)(3) Nonprofit Hospital

Financial Assistance Policy (FAP) & Amounts Generally Billed (AGB)

EIN: 951643360

Filing Period: 197607

Free Care Eligibility BenchmarkUp to 200% FPL100% charity write-off income threshold

Discounted Care EligibilityUp to 400% FPLSliding-scale & AGB billing cap tier

Charity Care Share of ExpensesSee Schedule HNet community financial assistance reported

26 U.S.C. § 501(r)(5) AGB Benchmark Method: lookback_commercial_median

Hospital-Specific CMS HCRIS Benchmark (17.9% of gross charges)

Under 26 U.S.C. § 501(r)(5), a tax-exempt hospital organization may not bill FAP-eligible patients more than Amounts Generally Billed (AGB) to individuals with insurance covering emergency or medically necessary care. Derived from this facility’s reported CMS HCRIS cost-to-charge & insurer allowance filings. Verify your exact Financial Assistance Policy (FAP) determination directly with the billing office.

Screen your household size, income, and itemized CPT codes against 2026 HHS Federal Poverty Guidelines: Calculate Your 501(r) Cap Above ↑

CMS Care Compare Public Quality Record

Clinical Quality, Patient Experience & Infection Benchmarks

CMS Overall3/5 Stars (3/5)

Safety Composite68/100

Would Recommend73%

Rated 9 or 10 (HCAHPS)73%

Median ER Wait228 min

Left ER Before Seen1%

30-Day Mortality vs U.S.same

Unplanned Readmissionbetter

Hip/Knee Complication Rate2.7%

Healthcare-Associated Infections (CDC NHSN / CMS HAI)

1.00 SIR = National Predicted Baseline (Lower Is Safer)

Central-Line Bloodstream Infectionsame

C. diff Hospital-Onset Infectionbetter

Source: CMS Hospital Care Compare (443 completed HCAHPS patient surveys). Clinical quality metrics summarize historical facility-wide cohorts and are not medical advice for individual care decisions.

Care-Setting Arbitrage, Bilateral SVD Insurer Leverage & Regional Alternatives

How to Pay Less Nearby: Freestanding Centers, Insurer Leverage & Outpatient Savings

Higher-Quality, Above-Median Price Tier

2D regional comparison of commercial negotiated price index against CMS clinical quality composite for Providence Mission Hospital.

Price Index: 1.11× regional baseline

Quality: 68/100 CMS composite

Notable Payer Contract Outliers (SVD Matrix Anomalies)

Providence

-49.9%

Median Household Income$113,702U.S. Census ACS

Local Uninsured Share6.8%Regional ACS estimate

200% FPL (1 Person)$31,920Common free-care ceiling

400% FPL (Family of 4)$128,600Common AGB cap ceiling

45 CFR § 180 Primary-Source Lineage & Federal Verification VeriRate 79/100 · Corroborated CMS CCN 050567 EIN 951643360

Verify the Raw Data: Official Hospital MRF, CMS Medicare.gov & Federal Filings

MRF Portal Indexed (CMS_45_CFR_180_FILING.json) Verify on CMS Medicare.gov (CCN 050567) ↗ Verify IRS Form 990 (EIN 951643360) ↗ CMS HCRIS Cost Reports ↗

Published MRF FileCMS_45_CFR_180_FILING.json

Publication / Vintage2026-04-01

Validated Rate Rows1,113 (CMS v3.0.0)

File Integrity DigestVerified · CCN 050567

Safe-Harbor Data Corrections: Parsed directly from public 45 CFR § 180 hospital filings, CMS Care Compare, and CMS HCRIS cost reports. Hospital compliance officers may submit updated MRF URLs or rate tables for verification.

Submit MRF Update Correction Policy