Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.
Original text from hospital filings
EXC BEN LES T/A/L 3.1-4CM
Los Angeles, CA
See all hospitals reporting CPT 11404 →Price type
Dignity Community Care’s median price of $2.1k is 18% above the median hospital's median price ($1.7k), higher than 63% of the 2,289 hospitals reporting CPT 11404. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 8 payers, 22 plan rates. A facility fee, a professional fee, a per diem and a case rate are different bills, so each is listed on its own. Open a payer to see it across hospitals.
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| # | |||||||
|---|---|---|---|---|---|---|---|
| 1 | Kaiser medicaid|< 21 fee schedule · outpatient | $153 | $153 | — | — | — | $153 – $153 |
| 2 | Kaiser medicaid|> 21 fee schedule · outpatient | $153 | $153 | — | — | — | $153 – $153 |
| 3 | Anthem medicaid|all plans fee schedule · outpatient | $159 | $159 | — | — | — | $159 – $159 |
| 4 | Molina medicaid|< 21 fee schedule · outpatient | $224 | $224 | — | — | — | $224 – $224 |
| 5 | Molina medicaid|> 21 fee schedule · outpatient | $224 | $224 | — | — | — | $224 – $224 |
| 6 | Blue Cross Blue Shield medicaid|all plans fee schedule · outpatient | $801 | $801 | — | — | — | $801 – $801 |
| 7 | Aetna medicare|all plans fee schedule · outpatient | $2.1k | $2.1k | — | — | — | $2.1k – $2.1k |
| 8 | Anthem medicare|all plans fee schedule · outpatient | $2.1k | $2.1k | — | — | — | $2.1k – $2.1k |
| 9 | Blue Cross Blue Shield medicare|all other plans case rate · outpatient | $2.1k | $2.1k | — | — | — | $2.1k – $2.1k |
| 10 | Molina medicare|all plans fee schedule · outpatient | $2.1k | $2.1k | — | — | — | $2.1k – $2.1k |
| 11 | UnitedHealthcare medicare|all plans case rate · outpatient | $2.1k | $2.1k | — | — | — | $2.1k – $2.1k |
| 12 | Blue Cross Blue Shield commercial|exchange case rate · outpatient | $2.8k | $2.8k | — | — | — | $2.8k – $2.8k |
| 13 | First Health commercial|all plans fee schedule · inpatient | $4.1k | $4.1k | — | — | — | $4.1k – $4.1k |
| 14 | First Health commercial|all plans fee schedule · outpatient | $4.1k | $4.1k | — | — | — | $4.1k – $4.1k |
| 15 | Kaiser commercial|all plans fee schedule · inpatient | $4.1k | $4.1k | — | — | — | $4.1k – $4.1k |
| 16 | Kaiser commercial|all plans fee schedule · outpatient | $4.1k | $4.1k | — | — | — | $4.1k – $4.1k |
| 17 | Blue Cross Blue Shield medicare|promise fee schedule · outpatient | $4.4k | $4.4k | — | — | — | $4.4k – $4.4k |
| 18 | MultiPlan commercial|all plans fee schedule · inpatient | $4.7k | $4.7k | — | — | — | $4.7k – $4.7k |
| 19 | MultiPlan commercial|all plans fee schedule · outpatient | $4.7k | $4.7k | — | — | — | $4.7k – $4.7k |
| 20 | Anthem commercial|exchange case rate · outpatient | $15.6k | $15.6k | — | — | — | $15.6k – $15.6k |
| 21 | Anthem commercial|all other plans case rate · outpatient | $23.6k | $23.6k | — | — | — | $23.6k – $23.6k |
| 22 | Anthem commercial|mcs case rate · outpatient | $29.0k | $29.0k | — | — | — | $29.0k – $29.0k |
Last updated: Feb 28, 2026
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