Nasal/sinus endo w/ethmoidectomy part 31254 at Bayshore Medical Center
727 North Beers St., Holmdel, NJ · Hackensack Meridian Health · · NPI 1760994412
$7,662.21
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.
$11,887.00
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.
$1,189.00 with UNITED HEALTHCARE vs $11,568.43 with AMERIHEALTH — 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 |
|---|---|---|---|
| UNITED HEALTHCARE | MANAGED MEDICAID | $1,189.00 | ↓ -84% |
| HORIZON | MANAGED MEDICAID | $1,308.00 | ↓ -83% |
| AETNA | MANAGED MEDICAID | $1,949.47 | ↓ -75% |
| CLOVER | MEDICARE ADVANTAGE | $2,139.66 | ↓ -72% |
| AETNA | MEDICARE ADVANTAGE | $2,151.55 | ↓ -72% |
| SEOUL MEDICAL GROUP | ALL PRODUCTS | $2,222.87 | ↓ -71% |
| CIGNA | HMO | $3,586.00 | ↓ -53% |
| CIGNA | PPO | $4,013.00 | ↓ -48% |
| QUALCARE | HMO | $6,256.00 | ↓ -18% |
| HORIZON | OMNIA | $6,984.00 | ↓ -9% |
| WELLCARE | MEDICARE ADVANTAGE | $7,662.21 | ↑ +0% |
| VACCN | ALL PRODUCTS | $7,662.21 | ↑ +0% |
| HORIZON BCBS BRAVEN | MEDICARE ADVANTAGE | $7,662.21 | ↑ +0% |
| WELLCARE | MANAGED MEDICAID | $7,662.21 | ↑ +0% |
| HORIZON | PIP | $7,667.12 | ↑ +0% |
| HORIZON | WORKERS COMP | $7,667.12 | ↑ +0% |
| HORIZON | SHP | $8,004.00 | ↑ +4% |
| UNITED COMMUNITY/AMERICHOICE | MEDICARE ADVANTAGE | $8,045.32 | ↑ +5% |
| OXFORD | ALL PRODUCTS | $8,143.00 | ↑ +6% |
| AETNA | PPO | $8,419.00 | ↑ +10% |
| AETNA | HMO | $8,419.00 | ↑ +10% |
| HORIZON | HMO | $8,627.00 | ↑ +13% |
| HORIZON | INDEMNITY | $8,748.00 | ↑ +14% |
| HORIZON | PPO | $8,830.00 | ↑ +15% |
| BERGEN RISK | ALL PRODUCTS | $8,915.25 | ↑ +16% |
| UNITED HEALTHCARE | DSNP | $9,194.65 | ↑ +20% |
| QUALCARE | PPO | $9,236.20 | ↑ +21% |
| AETNA | ASA | $9,307.52 | ↑ +21% |
| CIGNA | BH | $9,509.60 | ↑ +24% |
| BRIGHTON HEALTH PLAN | ALL PRODUCTS | $9,933.00 | ↑ +30% |
| MULTIPLAN - PHCS | ALL PRODUCTS | $10,103.95 | ↑ +32% |
| UNITED HEALTHCARE | HMO | $10,105.00 | ↑ +32% |
| AMERIHEALTH | LOCAL HMO | $10,213.31 | ↑ +33% |
| QUALCARE | WORKERS COMP | $10,460.56 | ↑ +37% |
| AMERIHEALTH | REGIONAL HMO | $11,568.43 | ↑ +51% |
| AMERIGROUP | MANAGED MEDICAID | not published by hospital | — |
| KARNA | MEDICARE ADVANTAGE | not published by hospital | — |
Visitor-reported prices
Comments
Nasal/sinus endo w/ethmoidectomy part 31254 at other New-jersey hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| Trinitas Regional Medical Center | Elizabeth | $5,855.00 | $225.70 – $15,130.86 |
| Cooperman Barnabas Medical Center | Livingston | $6,839.00 | $283.86 – $15,532.92 |
| Community Medical Center | Toms River | $3,786.00 | $290.70 – $15,055.21 |
| Clara Maass Medical Center | Belleville | $3,986.00 | $280.44 – $15,455.26 |
| Newark Beth Israel Medical Center | Newark | $4,881.00 | $232.33 – $15,532.92 |
| Jersey City Medical Center | Jersey City | $5,339.00 | $292.08 – $16,223.12 |
| Monmouth Medical Center | Long Branch | $5,419.00 | $560.88 – $15,247.80 |
| Hackensack University Medical Center | Hackensack | $8,152.32 | $512.66 – $8,559.93 |