Providence Mission Hospital
Providence Mission Hospital in Mission Viejo, CA charges 6.8x the Medicare reimbursement rate across 114 procedures analyzed, reflecting the pricing patterns typical of nonprofit-private healthcare facilities.
Mission Viejo, CA 92691 · Acute Care Hospitals · CMS Rating: 4/5
About the analyst
Priya Iyengar leads the billing code review team at BillRazor Research. She analyzes NCCI bundling edits, DRG coding, and regional rate variation. Expertise: NCCI bundling, DRG analysis, regional pricing.
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Pricing grade
D
High
Avg markup vs Medicare
6.77x
Charge / Medicare rate
Max markup
11.31x
Worst procedure
Procedures analyzed
114
With pricing data
Outlier procedures
0%
Above 90th percentile
Pricing grades reflect how this hospital's chargemaster (list) rates compare to Medicare reimbursement benchmarks within the same state. Grades measure pricing patterns only — not quality of care, patient outcomes, or clinical performance. A lower grade does not mean a hospital provides inferior care. Based on publicly available federal data. Not endorsed by or affiliated with any government agency.
| Procedure | Code | Gross charge | Cash price | Medicare | Markup |
|---|---|---|---|---|---|
| CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITHOUT CC/MCC | 310 | $39,190 | $19,595 | — | 11.3x |
| SEIZURES WITH MCC | 100 | $160,782 | $80,391 | — | 10.1x |
| DIABETES WITH CC | 638 | $54,501 | $27,251 | — | 9.4x |
| INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT CC/MCC | 066 | $47,568 | $23,784 | — | 9.3x |
| TRAUMATIC STUPOR AND COMA <1 HOUR WITH CC | 086 | $82,083 | $41,041 | — | 9x |
| TRAUMATIC STUPOR AND COMA >1 HOUR WITH CC | 083 | $83,554 | $41,777 | — | 9x |
| ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH CC | 281 | $61,496 | $30,748 | — | 8.7x |
| SYNCOPE AND COLLAPSE | 312 | $54,648 | $27,324 | — | 8.6x |
| INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH CC OR TPA IN 24 HOURS | 065 | $69,259 | $34,630 | — | 8.6x |
| MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH CC | 330 | $140,299 | $70,150 | — | 8.6x |
| FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITHOUT MCC | 563 | $53,793 | $26,897 | — | 8.5x |
| PERIPHERAL VASCULAR DISORDERS WITH MCC | 299 | $107,963 | $53,982 | — | 8.2x |
| OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH CC | 516 | $116,755 | $58,378 | — | 8.2x |
| MEDICAL BACK PROBLEMS WITHOUT MCC | 552 | $56,586 | $28,293 | — | 8.1x |
| CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH CC | 309 | $43,138 | $21,569 | — | 8.1x |
| TRAUMATIC STUPOR AND COMA >1 HOUR WITH MCC | 082 | $171,411 | $85,705 | — | 8.1x |
| POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITH MCC | 862 | $90,216 | $45,108 | — | 8x |
| SIMPLE PNEUMONIA AND PLEURISY WITH MCC | 193 | $86,274 | $43,137 | — | 8x |
| ENDOCRINE DISORDERS WITH CC | 644 | $56,647 | $28,323 | — | 7.9x |
| ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WIT | 062 | $127,563 | $63,781 | — | 7.9x |
| SIMPLE PNEUMONIA AND PLEURISY WITH CC | 194 | $44,118 | $22,059 | — | 7.8x |
| INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH CC | 854 | $122,629 | $61,315 | — | 7.7x |
| POISONING AND TOXIC EFFECTS OF DRUGS WITH MCC | 917 | $81,847 | $40,924 | — | 7.7x |
| GASTROINTESTINAL OBSTRUCTION WITH CC | 389 | $44,684 | $22,342 | — | 7.7x |
| ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MCC | 392 | $43,138 | $21,569 | — | 7.7x |
| MAJOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC | 331 | $98,909 | $49,455 | — | 7.6x |
| TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITHOUT MCC | 605 | $51,500 | $25,750 | — | 7.6x |
| OTHER RESPIRATORY SYSTEM DIAGNOSES WITH MCC | 205 | $104,039 | $52,020 | — | 7.6x |
| ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH MCC | 280 | $91,677 | $45,838 | — | 7.5x |
| REVISION OF HIP OR KNEE REPLACEMENT WITH CC | 467 | $173,655 | $86,827 | — | 7.5x |
| BRONCHITIS AND ASTHMA WITH CC/MCC | 202 | $50,107 | $25,054 | — | 7.5x |
| MAJOR CHEST PROCEDURES WITH CC | 164 | $156,174 | $78,087 | — | 7.5x |
| PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH DRUG-ELUTING STENT WITHOUT MCC | 247 | $92,708 | $46,354 | — | 7.4x |
| RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS | 207 | $414,108 | $207,054 | — | 7.3x |
| LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH CC | 493 | $140,436 | $70,218 | — | 7.3x |
| CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH MCC | 308 | $69,677 | $34,838 | — | 7.3x |
| SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS | 870 | $496,805 | $248,403 | — | 7.2x |
| CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITHOUT MCC | 287 | $62,581 | $31,291 | — | 7.2x |
| MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC | 470 | $100,943 | $50,471 | — | 7.2x |
| HEART FAILURE AND SHOCK WITH MCC | 291 | $71,403 | $35,701 | — | 7.1x |
| LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH CC | 418 | $85,265 | $42,633 | — | 7.1x |
| RENAL FAILURE WITH CC | 683 | $46,626 | $23,313 | — | 7.1x |
| TRAUMATIC STUPOR AND COMA <1 HOUR WITH MCC | 085 | $126,161 | $63,081 | — | 7.1x |
| MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITHOUT MCC | 641 | $40,872 | $20,436 | — | 7x |
| KIDNEY AND URINARY TRACT INFECTIONS WITHOUT MCC | 690 | $39,618 | $19,809 | — | 7x |
| NONSPECIFIC CEREBROVASCULAR DISORDERS WITH MCC | 070 | $90,959 | $45,479 | — | 7x |
| GASTROINTESTINAL HEMORRHAGE WITH CC | 378 | $50,696 | $25,348 | — | 7x |
| HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC | 522 | $117,327 | $58,664 | — | 7x |
| CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH MCC | 025 | $273,479 | $136,739 | — | 7x |
| PULMONARY EDEMA AND RESPIRATORY FAILURE | 189 | $74,110 | $37,055 | — | 6.9x |
Showing 50 of 114 procedures
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Pricing data from federal hospital transparency files and physician fee schedules. Last updated: . All data is publicly available under federal law.
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Data: Federal hospital pricing data, updated annually. All data publicly available under federal law.
Methodology: Hospital gross charges divided by Medicare payment for the same DRG. A ratio of 3.0x means the hospital's listed price is 3 times what Medicare pays. Chargemaster rates are list prices — they are not what most insured patients pay. Grades measure pricing patterns only — not quality of care or clinical performance.
This information is for educational purposes only and is not medical, financial, or legal advice. Actual costs depend on your insurance and provider. We recommend verifying costs directly with your provider. Full methodology · Terms of use