Biopsy of upper nose/throat at Southern Ocean Medical Center
1140 Route 72 West, Manahawkin, NJ · Hackensack Meridian Health · · NPI 1831601590
$3,544.29
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.
$260.95 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 | $260.95 | ↓ -93% |
| HORIZON | MANAGED MEDICAID | $903.00 | ↓ -75% |
| CLOVER | MEDICARE ADVANTAGE | $954.72 | ↓ -73% |
| AETNA | MANAGED MEDICAID | $981.24 | ↓ -72% |
| SEOUL MEDICAL GROUP | ALL PRODUCTS | $1,087.32 | ↓ -69% |
| UNITED HEALTHCARE | MANAGED MEDICAID | $1,189.00 | ↓ -66% |
| CIGNA | HMO | $2,249.00 | ↓ -37% |
| QUALCARE | HMO | $2,255.00 | ↓ -36% |
| CIGNA | PPO | $2,518.00 | ↓ -29% |
| HORIZON | PIP | $3,452.90 | ↓ -3% |
| WELLCARE | MEDICARE ADVANTAGE | $3,544.29 | ↑ +0% |
| HORIZON BCBS BRAVEN | MEDICARE ADVANTAGE | $3,544.29 | ↑ +0% |
| VACCN | ALL PRODUCTS | $3,544.29 | ↑ +0% |
| WELLCARE | MANAGED MEDICAID | $3,544.29 | ↑ +0% |
| HORIZON | WORKERS COMP | $3,563.76 | ↑ +1% |
| UNITED COMMUNITY/AMERICHOICE | MEDICARE ADVANTAGE | $3,721.50 | ↑ +5% |
| HORIZON | OMNIA | $3,830.02 | ↑ +8% |
| AETNA | MEDICARE ADVANTAGE | $3,863.27 | ↑ +9% |
| BERGEN RISK | ALL PRODUCTS | $3,978.00 | ↑ +12% |
| AETNA | ASA | $4,153.03 | ↑ +17% |
| CIGNA | BH | $4,243.20 | ↑ +20% |
| UNITED HEALTHCARE | DSNP | $4,253.14 | ↑ +20% |
| MULTIPLAN - PHCS | ALL PRODUCTS | $4,508.40 | ↑ +27% |
| HORIZON | SHP | $4,552.95 | ↑ +28% |
| AMERIHEALTH | LOCAL HMO | $4,605.99 | ↑ +30% |
| HORIZON | INDEMNITY | $4,720.56 | ↑ +33% |
| HORIZON | HMO | $4,723.74 | ↑ +33% |
| QUALCARE | WORKERS COMP | $4,816.03 | ↑ +36% |
| QUALCARE | PPO | $4,816.03 | ↑ +36% |
| HORIZON | PPO | $4,848.92 | ↑ +37% |
| AMERIHEALTH | REGIONAL HMO | $5,217.01 | ↑ +47% |
| OXFORD | ALL PRODUCTS | $6,189.00 | ↑ +75% |
| UNITED HEALTHCARE | HMO | $7,601.00 | ↑ +114% |
| AETNA | HMO | $9,383.00 | ↑ +165% |
| AETNA | PPO | $9,383.00 | ↑ +165% |
| BRIGHTON HEALTH PLAN | ALL PRODUCTS | $9,933.00 | ↑ +180% |
| AMERIGROUP | MANAGED MEDICAID | not published by hospital | — |
Visitor-reported prices
Comments
Biopsy of upper nose/throat at other New-jersey hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| Bayshore Medical Center | Holmdel | $3,589.62 | $3,589.62 – $4,307.55 |
| Hackensack University Medical Center | Hackensack | $3,819.23 | $271.94 – $4,010.20 |
| Ocean University Medical Center | Brick | $3,544.29 | $260.95 – $4,253.14 |
| JFK Johnson Rehabilitation Institute (JRI) | Edison | $3,592.74 | $94.38 – $3,592.74 |
| Jersey Shore University Medical Center | Neptune City | $3,589.62 | $260.95 – $4,307.55 |
| Palisades Medical Center | North Bergen | $3,819.23 | $271.94 – $4,162.96 |
| Raritan Bay Medical Center | Perth Amboy | $3,592.74 | $271.94 – $4,311.29 |
| Riverview Medical Center | Red Bank | $3,589.62 | $260.95 – $4,307.55 |