Biopsy of salivary glnd;incisional 42405 at Southern Ocean Medical Center
1140 Route 72 West, Manahawkin, NJ · Hackensack Meridian Health · · NPI 1831601590
$1,618.86
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.
$5,304.00
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.
$474.33 with KARNA vs $9,933.00 with BRIGHTON HEALTH PLAN — 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 |
|---|---|---|---|
| KARNA | MEDICARE ADVANTAGE | $474.33 | ↓ -71% |
| CLOVER | MEDICARE ADVANTAGE | $954.72 | ↓ -41% |
| AETNA | MANAGED MEDICAID | $981.24 | ↓ -39% |
| SEOUL MEDICAL GROUP | ALL PRODUCTS | $1,087.32 | ↓ -33% |
| HORIZON | MANAGED MEDICAID | $1,188.00 | ↓ -27% |
| UNITED HEALTHCARE | MANAGED MEDICAID | $1,189.00 | ↓ -27% |
| HORIZON BCBS BRAVEN | MEDICARE ADVANTAGE | $1,618.86 | ↑ +0% |
| WELLCARE | MEDICARE ADVANTAGE | $1,618.86 | ↑ +0% |
| WELLCARE | MANAGED MEDICAID | $1,618.86 | ↑ +0% |
| VACCN | ALL PRODUCTS | $1,618.86 | ↑ +0% |
| UNITED COMMUNITY/AMERICHOICE | MEDICARE ADVANTAGE | $1,699.80 | ↑ +5% |
| AETNA | MEDICARE ADVANTAGE | $1,764.56 | ↑ +9% |
| UNITED HEALTHCARE | DSNP | $1,942.63 | ↑ +20% |
| QUALCARE | HMO | $1,982.00 | ↑ +22% |
| CIGNA | HMO | $3,133.00 | ↑ +94% |
| HORIZON | PIP | $3,452.90 | ↑ +113% |
| CIGNA | PPO | $3,508.00 | ↑ +117% |
| HORIZON | WORKERS COMP | $3,563.76 | ↑ +120% |
| HORIZON | OMNIA | $3,830.02 | ↑ +137% |
| BERGEN RISK | ALL PRODUCTS | $3,978.00 | ↑ +146% |
| AETNA | ASA | $4,153.03 | ↑ +157% |
| CIGNA | BH | $4,243.20 | ↑ +162% |
| MULTIPLAN - PHCS | ALL PRODUCTS | $4,508.40 | ↑ +178% |
| HORIZON | SHP | $4,552.95 | ↑ +181% |
| AMERIHEALTH | LOCAL HMO | $4,605.99 | ↑ +185% |
| HORIZON | INDEMNITY | $4,720.56 | ↑ +192% |
| HORIZON | HMO | $4,723.74 | ↑ +192% |
| QUALCARE | PPO | $4,816.03 | ↑ +197% |
| QUALCARE | WORKERS COMP | $4,816.03 | ↑ +197% |
| HORIZON | PPO | $4,848.92 | ↑ +200% |
| AMERIHEALTH | REGIONAL HMO | $5,217.01 | ↑ +222% |
| OXFORD | ALL PRODUCTS | $6,189.00 | ↑ +282% |
| UNITED HEALTHCARE | HMO | $7,601.00 | ↑ +370% |
| AETNA | PPO | $9,383.00 | ↑ +480% |
| AETNA | HMO | $9,383.00 | ↑ +480% |
| BRIGHTON HEALTH PLAN | ALL PRODUCTS | $9,933.00 | ↑ +514% |
| AMERIGROUP | MANAGED MEDICAID | not published by hospital | — |
Visitor-reported prices
Comments
Biopsy of salivary glnd;incisional 42405 at other New-jersey hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| Bayshore Medical Center | Holmdel | $1,639.57 | $1,639.57 – $1,967.48 |
| Hackensack University Medical Center | Hackensack | $1,744.44 | $490.93 – $1,831.67 |
| Ocean University Medical Center | Brick | $1,618.86 | $474.33 – $1,942.63 |
| JFK Johnson Rehabilitation Institute (JRI) | Edison | $1,640.99 | $81.20 – $1,640.99 |
| Jersey Shore University Medical Center | Neptune City | $1,639.57 | $474.33 – $1,967.48 |
| Palisades Medical Center | North Bergen | $1,744.44 | $490.93 – $1,901.44 |
| Raritan Bay Medical Center | Perth Amboy | $1,640.99 | $490.93 – $1,969.19 |
| Riverview Medical Center | Red Bank | $1,639.57 | $474.33 – $1,967.48 |