Bx nasopharynx/unknown pri lesion 42806 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.
$7,068.00
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.
$299.36 with KARNA vs $10,216.00 with UNITED HEALTHCARE — 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 | $299.36 | ↓ -92% |
| HORIZON | MANAGED MEDICAID | $1,188.00 | ↓ -66% |
| UNITED HEALTHCARE | MANAGED MEDICAID | $1,189.00 | ↓ -66% |
| CLOVER | MEDICARE ADVANTAGE | $1,272.24 | ↓ -64% |
| AETNA | MANAGED MEDICAID | $1,307.58 | ↓ -63% |
| SEOUL MEDICAL GROUP | ALL PRODUCTS | $1,448.94 | ↓ -59% |
| QUALCARE | HMO | $1,982.00 | ↓ -44% |
| CIGNA | HMO | $3,133.00 | ↓ -12% |
| CIGNA | PPO | $3,508.00 | ↓ -1% |
| HORIZON BCBS BRAVEN | MEDICARE ADVANTAGE | $3,544.29 | ↑ +0% |
| WELLCARE | MEDICARE ADVANTAGE | $3,544.29 | ↑ +0% |
| WELLCARE | MANAGED MEDICAID | $3,544.29 | ↑ +0% |
| VACCN | ALL PRODUCTS | $3,544.29 | ↑ +0% |
| UNITED COMMUNITY/AMERICHOICE | MEDICARE ADVANTAGE | $3,721.50 | ↑ +5% |
| AETNA | MEDICARE ADVANTAGE | $3,863.27 | ↑ +9% |
| UNITED HEALTHCARE | DSNP | $4,253.14 | ↑ +20% |
| HORIZON | PIP | $4,601.27 | ↑ +30% |
| HORIZON | WORKERS COMP | $4,748.99 | ↑ +34% |
| HORIZON | OMNIA | $5,103.80 | ↑ +44% |
| BERGEN RISK | ALL PRODUCTS | $5,301.00 | ↑ +50% |
| AETNA | ASA | $5,534.24 | ↑ +56% |
| CIGNA | BH | $5,654.40 | ↑ +60% |
| MULTIPLAN - PHCS | ALL PRODUCTS | $6,007.80 | ↑ +70% |
| HORIZON | SHP | $6,067.17 | ↑ +71% |
| AMERIHEALTH | LOCAL HMO | $6,137.85 | ↑ +73% |
| HORIZON | INDEMNITY | $6,290.52 | ↑ +77% |
| HORIZON | HMO | $6,294.76 | ↑ +78% |
| QUALCARE | PPO | $6,417.74 | ↑ +81% |
| QUALCARE | WORKERS COMP | $6,417.74 | ↑ +81% |
| HORIZON | PPO | $6,461.57 | ↑ +82% |
| AMERIHEALTH | REGIONAL HMO | $6,952.08 | ↑ +96% |
| OXFORD | ALL PRODUCTS | $8,251.00 | ↑ +133% |
| AETNA | HMO | $9,383.00 | ↑ +165% |
| AETNA | PPO | $9,383.00 | ↑ +165% |
| BRIGHTON HEALTH PLAN | ALL PRODUCTS | $9,933.00 | ↑ +180% |
| UNITED HEALTHCARE | HMO | $10,216.00 | ↑ +188% |
| AMERIGROUP | MANAGED MEDICAID | not published by hospital | — |
Visitor-reported prices
Comments
Bx nasopharynx/unknown pri lesion 42806 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 | $311.44 – $4,010.20 |
| Ocean University Medical Center | Brick | $3,544.29 | $299.36 – $4,253.14 |
| JFK Johnson Rehabilitation Institute (JRI) | Edison | $3,592.74 | $109.20 – $3,592.74 |
| Jersey Shore University Medical Center | Neptune City | $3,589.62 | $299.36 – $4,307.55 |
| Palisades Medical Center | North Bergen | $3,819.23 | $311.44 – $4,162.96 |
| Raritan Bay Medical Center | Perth Amboy | $3,592.74 | $311.44 – $4,311.29 |
| Riverview Medical Center | Red Bank | $3,589.62 | $299.36 – $4,307.55 |