King City, CA
61
Beds
389
Inpatient discharges a year
$77.6M
Net patient revenue a year
24
In-network payers
GEORGE L. MEE MEMORIAL HOSPITAL is a 61-bed hospital in King City, CA. Below you'll find publicly disclosed negotiated rates and facility details, including 24 in-network payers and 117 disclosed rate categories.
The 24 services GEORGE L. MEE MEMORIAL HOSPITAL most likely performs, ranked by likely volume and what it is paid. Each service names one insurer. * marks hidden insurer names; A, B and C rank the remaining rates from low to high and reset for each service.
Book a demo to see hidden insurer names, more payer rates, and hospital data, or start a free trial.
Cardiology and vascular testing
CPT 93306
$4,783 - $5,676
from 4 insurers · median $5,355
Typical for a hospital with this service line
Digestive procedures
CPT 45378
$820 - $14,226
from 2 insurers · median $7,523
Typical for a hospital with this service line
Mammography
CPT 77067
$84 - $622
from 4 insurers · median $452
Typical for a hospital with this service line
MRI imaging
CPT 72148
$400 - $4,774
from 3 insurers · median $4,434
Typical for a hospital with this service line
X-ray and bone density
CPT 71046
$112 - $845
from 4 insurers · median $474
Typical for a hospital with this service line
MRI imaging
CPT 74183
$6,285 - $7,044
from 3 insurers · median $7,027
Typical for a hospital with this service line
MRI imaging
CPT 73721
$400 - $4,331
from 4 insurers · median $4,055
Typical for a hospital with this service line
MRI imaging
CPT 70553
$6,782
negotiated rate
Typical for a hospital with this service line
Cardiology and vascular testing
CPT 93971
$1,652 - $1,960
from 4 insurers · median $1,841
Typical for a hospital with this service line
Ultrasound
CPT 76536
$313 - $1,633
from 4 insurers · median $1,540
Typical for a hospital with this service line
Ultrasound
CPT 76830
$110 - $1,324
from 4 insurers · median $1,231
Typical for a hospital with this service line
Cardiology and vascular testing
CPT 93970
$2,410 - $2,860
from 4 insurers · median $2,698
Typical for a hospital with this service line
X-ray and bone density
CPT 77080
$823 - $977
from 4 insurers · median $921
Typical for a hospital with this service line
Ultrasound
CPT 76705
$104 - $1,637
from 4 insurers · median $569
Typical for a hospital with this service line
Cardiology and vascular testing
CPT 93880
$190 - $2,648
from 4 insurers · median $2,467
Typical for a hospital with this service line
Lung function and sleep
CPT 95810
$4,971 - $5,899
from 4 insurers · median $5,564
Typical for a hospital with this service line
X-ray and bone density
CPT 73630
$36 - $859
from 4 insurers · median $509
Typical for a hospital with this service line
X-ray and bone density
CPT 73562
$151 - $822
from 4 insurers · median $775
Typical for a hospital with this service line
Lung function and sleep
CPT 95811
$5,820 - $6,907
from 4 insurers · median $6,515
Typical for a hospital with this service line
Ultrasound
CPT 76856
$172 - $1,623
from 4 insurers · median $635
Typical for a hospital with this service line
Mammography
CPT 77066
$627 - $744
from 4 insurers · median $702
Typical for a hospital with this service line
Mammography
CPT 77065
$483 - $573
from 4 insurers · median $541
Typical for a hospital with this service line
Lung function and sleep
CPT 94060
$311 - $1,698
from 4 insurers · median $1,476
Typical for a hospital with this service line
CT imaging
CPT 70450
$210
negotiated rate
Typical for a hospital with this service line
Median rate as a percent of Medicare across the outpatient services above, and how many services sit above or below the same insurer's median at nearby hospitals. * marks hidden insurer names. These table labels track the same insurers across services; the labels on each service card reset.
| Insurer | Services | Median % of Medicare | Above nearby | Below nearby |
|---|---|---|---|---|
| Insurer A* | 22 | 959% | 0 | 0 |
| Insurer B* | 20 | 928% | 0 | 0 |
| Insurer C* | 22 | 615% | 0 | 0 |
| Insurer D* | 22 | 609% | 0 | 0 |
How we chose these services: 0 appear in this hospital's own Medicare claims, 0 are common here based on CMS Medicare volume, and 24 are typical for the service lines it reports to CMS. Rates come from insurer and hospital price transparency files as of October 2026. Rates under a quarter of Medicare or over 20 times Medicare are left out as likely physician-fee rows or file errors. Book a demo to see all 300 CMS shoppable services for GEORGE L. MEE MEMORIAL HOSPITAL, or start a free trial.
Acceptance varies by plan and service. Confirm coverage with your insurer or the hospital's billing department.
Doctors and services
Accredited by The Joint Commission
Finances
$77.6M net patient revenue
Ownership and leadership
Other
300 CANAL ST, King City, CA 939303431
The Joint Commission (since 2016)
Accreditation
None
Medical school affiliation
Other
Ownership type
25
Medicare-certified beds
2020
In Medicare since
Source: CMS Provider of Services file, as reported by the hospital and state surveyors.
What GEORGE L. MEE MEMORIAL HOSPITAL reported to Medicare in its latest cost report, covering Oct 1, 2024 to Sep 30, 2025.
389
Inpatient discharges
Medicare 28%, Medicaid 44%
2,426
Inpatient days
51% of available bed days used
173
Employees (full-time equivalent)
Source: CMS cost report (HCRIS) (report 843916). Figures cover the reporting period, which is not always 12 months, and are self-reported.
Inpatient days and discharges GEORGE L. MEE MEMORIAL HOSPITAL reported by payer. Medicare and Medicaid include their managed care plans, shown separately below.
| Medicare | Medicaid | Other | Total | |
|---|---|---|---|---|
| Inpatient days | 951 | 155 | 1,320 | 2,426 |
| Discharges | 109 | 173 | 107 | 389 |
| Average length of stay | 8.7 days | 0.9 days | 12.3 days | 6.2 days |
| Average daily census | 2.6 | 0.4 | 3.6 | 6.6 |
325
Medicaid managed care days
174
Observation bed days
| Unit | Beds | Inpatient days | Medicare days | Occupancy |
|---|---|---|---|---|
| Adults & pediatrics | 13 | 896 | 327 | 19% |
| Skilled nursing facility | 48 | 13,463 | 8,705 | 77% |
Source: CMS cost report (HCRIS, Form 2552-10), report 843916, amended. Hospitals report these figures themselves; they are not audited financial statements. Worksheet S-3 Part I.
ZIP codes with the most Medicare inpatient stays at GEORGE L. MEE MEMORIAL HOSPITAL in 2025. Market share is this hospital's part of every hospital's Medicare stays from the ZIP code. Its published Medicare stays went from 64 in 2020 to 91 in 2025.
| ZIP code | Stays | Of this hospital's stays | Days | Charges | Market share | Share in 2020 |
|---|---|---|---|---|---|---|
| 93930 | 73 | 80% | 235 | $2.8M | 20% | 13% |
| 93927 | 18 | 20% | 46 | $570,211 | 5% | 6% |
Source: CMS Hospital Service Area file. Shares are of the 91 stays from ZIP codes CMS publishes; it omits ZIP codes with fewer than 11 stays, so market shares count published stays only.
Staff by profession and the rooms and units GEORGE L. MEE MEMORIAL HOSPITAL reported at its latest Medicare certification survey (2023). Counts are people, not full-time equivalents.
2
Operating rooms
3
Off-site locations
Source: CMS Provider of Services file.
85 clinicians who bill Medicare list GEORGE L. MEE MEMORIAL HOSPITAL as a hospital affiliation. Showing 24 of them. Book a demo to see the commercial rates insurers publish for them, or start a free trial.
Katrina Fischer
Hematology & Oncology Physician
NPI 1477972388
See commercial rates for Katrina FischerMichael Basse, M.D.
Diagnostic Radiology Physician
NPI 1346204146
See commercial rates for Michael Basse, M.D.Salar Deldar, M.D.
Pain Medicine (Physical Medicine & Rehabilitation) Physician
NPI 1578799193
See commercial rates for Salar Deldar, M.D.Gloria Hwang
Pain Medicine (Physical Medicine & Rehabilitation) Physician
NPI 1447632773
See commercial rates for Gloria HwangLeonard Renfer, MD
Urology Physician
NPI 1235184912
See commercial rates for Leonard Renfer, MDAdam Holleran, M.D.
Orthopaedic Surgery Physician
NPI 1568627602
See commercial rates for Adam Holleran, M.D.Michael Dicus, MD
Nephrology Physician
NPI 1447339452
See commercial rates for Michael Dicus, MDAytac Apaydin, MD
Urology Physician
NPI 1689606741
See commercial rates for Aytac Apaydin, MDHarlan Grogin, M.D.
Clinical Cardiac Electrophysiology Physician
NPI 1144228180
See commercial rates for Harlan Grogin, M.D.Thomas Mustoe, M.D.
Interventional Cardiology Physician
NPI 1952309908
See commercial rates for Thomas Mustoe, M.D.Christopher Oh, M.D.
Nuclear Cardiology Physician
NPI 1942208889
See commercial rates for Christopher Oh, M.D.Megan May, M.D.
Internal Medicine Physician
NPI 1407155211
See commercial rates for Megan May, M.D.Patrik Zetterlund, M.D.
Interventional Cardiology Physician
NPI 1942208848
See commercial rates for Patrik Zetterlund, M.D.Daniel Luba, M.D.
Gastroenterology Physician
NPI 1790786002
See commercial rates for Daniel Luba, M.D.Robert Isom, M.D.
Nephrology Physician
NPI 1356428072
See commercial rates for Robert Isom, M.D.Dale Helman, MD
Neurology Physician
NPI 1407926009
See commercial rates for Dale Helman, MDRichard Gerber, M.D.
Interventional Cardiology Physician
NPI 1407854599
See commercial rates for Richard Gerber, M.D.Rikin Kadakia, M.D.
Interventional Cardiology Physician
NPI 1154718526
See commercial rates for Rikin Kadakia, M.D.Robert Revers, M.D
Endocrinology, Diabetes & Metabolism Physician
NPI 1598762718
See commercial rates for Robert Revers, M.DRoberto Tongson, M.D.
Specialist
NPI 1467450676
See commercial rates for Roberto Tongson, M.D.Robert Fry, M.D.
Orthopaedic Surgery Physician
NPI 1679738504
See commercial rates for Robert Fry, M.D.Marc Lieberman, MD
Rheumatology Physician
NPI 1528159092
See commercial rates for Marc Lieberman, MDHong Zhao, M.D.
Hematology & Oncology Physician
NPI 1568696896
See commercial rates for Hong Zhao, M.D.Arvind Bhat, M.D.
Hospitalist Physician
NPI 1861434763
See commercial rates for Arvind Bhat, M.D.Source: CMS Doctors and Clinicians facility affiliations, released 2026-10-15, with names and specialties from NPPES. Affiliation means the clinician bills Medicare for care at this hospital; it is not employment.
Revenue, expenses and income GEORGE L. MEE MEMORIAL HOSPITAL reported to Medicare for Oct 1, 2024 to Sep 30, 2025. Percentages are of net patient revenue.
| Line | Amount | Share |
|---|---|---|
| Gross patient revenue (charges) | $234.6M | 302.4% |
| Inpatient | $42.5M | 54.8% |
| Outpatient | $192.1M | 247.6% |
| Contractual allowances and discounts | -$157M | -202.4% |
| Net patient revenue | $77.6M | 100.0% |
| Operating expenses | -$73.3M | -94.4% |
| Operating income from patient care | $4.3M | 5.6% |
| Other income | $2.6M | 3.4% |
| Contributions and donations | $11,608 | 0.0% |
| Investment income | $528,681 | 0.7% |
| Government appropriations | $451,120 | 0.6% |
| Other | $1.7M | 2.1% |
| Net income | $7M | 9.0% |
| Line | Amount | Share |
|---|---|---|
| Traditional Medicare | $26.7M | 11.5% |
| Medicaid (including managed care) | $130.7M | 56.6% |
| Other payers and self-pay | $73.5M | 31.8% |
| Total charges | $230.9M | 100.0% |
Source: CMS cost report (HCRIS, Form 2552-10), report 843916, amended. Hospitals report these figures themselves; they are not audited financial statements. Traditional Medicare is the program charges on Worksheets D-3 and D Part V; Medicaid is from Worksheet S-10.
Computed from GEORGE L. MEE MEMORIAL HOSPITAL's latest cost report.
5.6%
Operating margin
Operating income from patient care / net patient revenue
8.7%
Total margin
Net income / net patient revenue plus other income
11.0%
EBITDAR margin
Net income before interest, depreciation and leases (Worksheet A-7), / total revenue
43% of expenses
Personnel costs
Salaries, direct-care contract labor and core wage-related costs / operating expenses
9.9%
Return on assets
Net income for a year / total assets
12.7%
Return on equity
Net income for a year / fund balance
3.21
Current ratio
Current assets / current liabilities
1.94
Quick ratio
Cash, temporary investments and net receivables / current liabilities
102 days
Days cash on hand
Cash and temporary investments / daily operating expenses excluding depreciation
35 days
Days in patient receivables
Net patient receivables / daily net patient revenue
72 days
Average payment period
Current liabilities / daily operating expenses excluding depreciation
1.14
Asset turnover
Total revenue for a year / total assets
21.9 years
Average age of plant
Accumulated depreciation / depreciation for a year
Source: CMS cost report (HCRIS, Form 2552-10), report 843916, amended. Hospitals report these figures themselves; they are not audited financial statements.
What GEORGE L. MEE MEMORIAL HOSPITAL owned and owed at the end of its reporting period (Sep 2025), across all fund types: $70.5M in total assets and a $54.9M fund balance.
| Line | Amount | Of total assets |
|---|---|---|
| Cash and temporary investments | $19.9M | 28.3% |
| Patient receivables, net | $7.5M | 10.6% |
| Inventory | $755,284 | 1.1% |
| Total current assets | $45.5M | 64.5% |
| Property and equipment, net of depreciation | $23.6M | 33.4% |
| Investments and other assets | $1.4M | 2.0% |
| Total assets | $70.5M | 100.0% |
| Current liabilities | $14.2M | 20.1% |
| Total liabilities | $15.5M | 22.1% |
| Fund balance (net assets) | $54.9M | 77.9% |
Source: CMS cost report (HCRIS, Form 2552-10), report 843916, amended. Hospitals report these figures themselves; they are not audited financial statements.
Care GEORGE L. MEE MEMORIAL HOSPITAL provided without full payment, as reported on Worksheet S-10 of its cost report.
$738,180
Cost of charity care
Care for patients approved for charity care and uninsured discounts, at cost
$4M
Bad debt
Patient bills written off as uncollectible, at charges
$16.8M
Medicaid shortfall
Cost of Medicaid patients (charges times the cost-to-charge ratio) minus Medicaid payments; negative means a surplus
$18.7M
Total unreimbursed and uncompensated care
25.5% of operating expenses
Medicaid, CHIP and indigent care shortfalls plus charity care and the cost of bad debt (Worksheet S-10 line 31)
Source: CMS cost report (HCRIS, Form 2552-10), report 843916, amended. Hospitals report these figures themselves; they are not audited financial statements.
GEORGE L. MEE MEMORIAL HOSPITAL's full-year cost reports, by fiscal year end. Reports shorter than ten months are left out.
| Fiscal year ending | Sep 2021 | Sep 2022 | Sep 2023 | Sep 2024 | Sep 2025 |
|---|---|---|---|---|---|
| Net patient revenue | $72.6M | $67.6M | $68.1M | $68.1M | $77.6M |
| Operating expenses | $60.7M | $65.3M | $68.3M | $72.6M | $73.3M |
| Operating margin | 16.4% | 3.3% | -0.3% | -6.6% | 5.6% |
| Net income | $21.5M | $19.8M | $4M | -$143,052 | $7M |
| Total assets | $37.8M | $13.3M | $13.4M | $59.6M | $70.5M |
| Discharges | 388 | 415 | 442 | 369 | 389 |
| Inpatient days | 1,199 | 2,118 | 2,495 | 1,760 | 2,426 |
| Beds | 61 | 61 | 61 | 61 | 61 |
| Employees (FTE) | 173 | 46 | 214 | 219 | 173 |
Source: CMS cost report (HCRIS, Form 2552-10), report 843916, amended. Hospitals report these figures themselves; they are not audited financial statements.
Each cost center GEORGE L. MEE MEMORIAL HOSPITAL reports, largest first. Total cost includes its share of overhead; the cost-to-charge ratio is total cost / charges.
| Department | Salaries | Total cost | Charges | Cost-to-charge | Square feet |
|---|---|---|---|---|---|
| Emergency | $1.8M | $11.3M | $55.1M | 0.21 | 2,449 |
| Rural health clinic ii | $4.2M | $10.4M | $14.8M | 0.71 | 6,864 |
| Rural health clinic | $3.9M | $9.5M | $12.5M | 0.76 | 7,165 |
| Laboratory | $1.4M | $5.8M | $40.4M | 0.14 | 1,409 |
| Radiology-diagnostic | $1.4M | $5.3M | $45.9M | 0.11 | 2,744 |
| Operating room | $1.6M | $3.9M | $12.6M | 0.31 | 3,005 |
| Physical therapy | $481,907 | $1.8M | $5.1M | 0.36 | 3,698 |
| Rural health clinic iii | $1.3M | $1.6M | 0.86 | 1,194 | |
| Drugs charged to patients | $1.2M | $5M | 0.25 | ||
| Medical supplies charged to patient | $1.2M | $1.9M | 0.66 | ||
| Respiratory therapy | $486,599 | $1.1M | $4.3M | 0.26 | 1,103 |
| Observation beds (non-distinct part | $590,011 | $1.2M | 0.48 | ||
| Occupational therapy | $407,504 | $2.1M | 0.20 | ||
| Impl. dev. charged to patients | $377,544 | $766,580 | 0.49 | ||
| Electrocardiology | $175,731 | $2.8M | 0.06 | ||
| Clinic | $695,762 | $118,659 | $58,766 | 2.02 | 196 |
| Whole blood & packed red blood cell | $105,493 | $237,382 | 0.44 | 87 | |
| Anesthesiology | $95,551 | $1.8M | 0.05 | 144 | |
| Speech pathology | $19,649 | $73,442 | 0.27 |
| Department | Salaries | Total cost | Charges | Cost-to-charge | Square feet |
|---|---|---|---|---|---|
| Skilled nursing facility | $2.8M | $7.6M | $12.2M | 0.63 | 7,845 |
| Adults & pediatrics | $1.7M | $6.5M | $10.4M | 0.62 | 12,335 |
| Department | Salaries | Direct cost | Paid hours | Average hourly wage | Square feet |
|---|---|---|---|---|---|
| Employee benefits department | $3.6M | $8.4M | 2,155 | ||
| Other administrative and general | $2.4M | $5.7M | 14,299 | ||
| Patient financial services | $1.1M | $4.7M | 1,623 | ||
| Operation of plant | $2M | 8,095 | |||
| Nursing administration | $1.3M | $1.5M | 552 | ||
| Maintenance & repairs | $740,721 | $1.4M | |||
| Cap rel costs-bldg & fixt | $1.3M | 94,433 | |||
| Housekeeping | $1.1M | 5,531 | |||
| Dietary | $1.1M | 3,637 | |||
| Medical records & library | $335,119 | $853,883 | 2,320 | ||
| Admissions | $728,389 | $825,228 | 307 | ||
| Pharmacy | $483,755 | $657,559 | 1,368 | ||
| Cap rel costs-mvble equip | $551,067 | ||||
| Cafeteria | $446,099 | ||||
| Central services & supply | $218,594 | $350,628 | 4,087 | ||
| Laundry & linen service | $122,931 | ||||
| Social service | $115,509 | $119,410 | 221 |
Source: CMS cost report (HCRIS, Form 2552-10), report 843916, amended. Hospitals report these figures themselves; they are not audited financial statements. Worksheets A, B-1, C Part I and S-3 Part II.
The officers and board members on GEORGE L. MEE MEMORIAL HOSPITAL's Medicare enrollment and on the IRS Form 990 filed under its tax ID.
Source: CMS Hospital All Owners (PECOS), the people the hospital lists on its Medicare enrollment; the first 6 of 13 are shown.
340B drug pricing program
Participating since 2021
340B ID CAH051336-00, registered as a critical access hospital; 3 registered outpatient sites; 16 active contract pharmacies. Authorizing official: Rena Salamacha, CEO.
Source: HRSA 340B Office of Pharmacy Affairs Information System.
Mee memorial hospital
CCN 05Z336, certified 2000, Medicare cost reimbursed
Mee memorial snf
CCN 056443, certified 1984, Medicare prospective payment
Greenfield rhc (mee memorial)
CCN 058558, certified 1997, Medicare cost reimbursed
King city rhc (mee memorial)
CCN 058562, certified 1998, Medicare cost reimbursed
Childrens health and wellness
CCN 058732, certified 2024, Medicare cost reimbursed
Mee memorial outpat. ctr.
CCN 053521, certified 1994
Source: Worksheet S-2 Part I of GEORGE L. MEE MEMORIAL HOSPITAL's latest Medicare cost report (HCRIS).
About GEORGE L. MEE MEMORIAL HOSPITAL's rates and hospital price transparency.
For MRI lumbar spine without contrast (CPT 72148), published negotiated rates at GEORGE L. MEE MEMORIAL HOSPITAL range from $400 to $4,774 across 3 insurers. Anthem Blue Cross / Blue Shield of CA's rate is $4,434. What a patient pays depends on their plan's deductible, coinsurance and network status.
For CT head or brain without contrast (CPT 70450), published negotiated rates at GEORGE L. MEE MEMORIAL HOSPITAL range from $210 to $210 across 1 insurers. UnitedHealthcare's rate is $210. What a patient pays depends on their plan's deductible, coinsurance and network status.
For Diagnostic colonoscopy (CPT 45378), published negotiated rates at GEORGE L. MEE MEMORIAL HOSPITAL range from $820 to $14,226 across 2 insurers. UnitedHealthcare's rate is $820. What a patient pays depends on their plan's deductible, coinsurance and network status.
For Screening mammography, bilateral (CPT 77067), published negotiated rates at GEORGE L. MEE MEMORIAL HOSPITAL range from $84 to $622 across 4 insurers. Aetna's rate is $84. What a patient pays depends on their plan's deductible, coinsurance and network status.
GEORGE L. MEE MEMORIAL HOSPITAL reported 389 inpatient discharges and 2,426 inpatient days from Oct 1, 2024 to Sep 30, 2025.
GEORGE L. MEE MEMORIAL HOSPITAL reported 173 full-time-equivalent employees on payroll from Oct 1, 2024 to Sep 30, 2025.
GEORGE L. MEE MEMORIAL HOSPITAL reported $77.6M in net patient revenue on $234.6M of gross charges for Oct 1, 2024 to Sep 30, 2025, an operating margin of 5.6%, and net income of $7M.
GEORGE L. MEE MEMORIAL HOSPITAL reported $18.7M of unreimbursed and uncompensated care for Oct 1, 2024 to Sep 30, 2025, including $738,180 of charity care at cost.
GEORGE L. MEE MEMORIAL HOSPITAL's Medicare enrollment lists Rena Salamacha as CEO since 2019.
Yes. HRSA's 340B database lists GEORGE L. MEE MEMORIAL HOSPITAL (340B ID CAH051336-00) as a participating critical access hospital since 2021, with 16 active contract pharmacies.
85 clinicians who bill Medicare list GEORGE L. MEE MEMORIAL HOSPITAL as a hospital affiliation in CMS's Doctors and Clinicians data. The largest groups are family medicine physician (13), emergency medicine physician (8), cardiovascular disease physician (5).
Yes. CMS's Provider of Services file lists The Joint Commission as the accrediting organization for GEORGE L. MEE MEMORIAL HOSPITAL, effective 2016.
In CMS's 2025 Hospital Service Area file, the most Medicare inpatient stays at GEORGE L. MEE MEMORIAL HOSPITAL came from ZIP codes 93930 (73), 93927 (18).
GEORGE L. MEE MEMORIAL HOSPITAL has 61 beds, including its psychiatric, rehabilitation and other subprovider units, in its latest Medicare cost report. 25 are Medicare-certified beds in CMS's Provider of Services file. Facility type: HOSPITAL.
GEORGE L. MEE MEMORIAL HOSPITAL is located at 300 CANAL ST, King City, CA 939303431.
GEORGE L. MEE MEMORIAL HOSPITAL's CMS Certification Number (CCN), also called its Medicare provider number, is 051336.
The National Provider Identifier (NPI) on file for GEORGE L. MEE MEMORIAL HOSPITAL is 1114917564.
GEORGE L. MEE MEMORIAL HOSPITAL lists 24 in-network payers, including Aetna, Ameri Health, Aspirus Health Plan, Avera Health Plans, and is Medicare-certified. Insurance acceptance may vary by plan, so confirm coverage with your insurer or the hospital's billing department.
117 disclosed rate categories. Each shows the payer, category, code type and group with its code range, and contract type, along with how the rate compares with the state average.
Under 45 CFR Part 180, every US hospital must publish a machine-readable file of its standard charges, including gross charges, discounted cash prices and payer-specific negotiated rates, in the CMS template format. PayerPrice can help hospitals publish and maintain these files.
A chargemaster (charge description master, or CDM) is a hospital's master list of billable items, with codes, descriptions and gross charges. A chargemaster review looks at those lines for accuracy and pricing. PayerPrice can help hospitals review their chargemaster; contact us to discuss your needs.
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{
"description": "MRI of brain (no contrast)",
"code_information": [
{ "code": "611", "type": "RC" },
{ "code": "70551", "type": "CPT" }
],
"standard_charges": [{
"setting": "outpatient",
"minimum": 250,
"maximum": 400,
"gross_charge": 1200,
"discounted_cash": 1080,
"payers_information": [
{
"payer_name": "Platform Health Insurance",
"plan_name": "PPO",
"methodology": "fee schedule",
"standard_charge_dollar": 400
},
{
"payer_name": "Region Health Insurance",
"plan_name": "HMO",
"methodology": "fee schedule",
"standard_charge_dollar": 250
}
]
}]
}Your chargemaster sets the gross charge on every claim, and many payer contracts base payment on it through percent-of-charge, lesser-of and stop-loss terms. We audit it line by line and show how your charges and negotiated rates compare with peer hospitals before your next negotiation.
What a review covers