Lengthening of palate+pharyngeal flap 42226 at Southern Ocean Medical Center
1140 Route 72 West, Manahawkin, NJ · Hackensack Meridian Health · · NPI 1831601590
$6,465.11
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.
$16,016.00
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.
$1,898.47 with KARNA vs $19,696.00 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 | $1,898.47 | ↓ -71% |
| HORIZON | MANAGED MEDICAID | $1,915.00 | ↓ -70% |
| UNITED HEALTHCARE | MANAGED MEDICAID | $2,379.00 | ↓ -63% |
| CLOVER | MEDICARE ADVANTAGE | $2,882.88 | ↓ -55% |
| AETNA | MANAGED MEDICAID | $2,962.96 | ↓ -54% |
| QUALCARE | HMO | $3,112.00 | ↓ -52% |
| SEOUL MEDICAL GROUP | ALL PRODUCTS | $3,283.28 | ↓ -49% |
| CIGNA | HMO | $5,022.00 | ↓ -22% |
| CIGNA | PPO | $5,631.00 | ↓ -13% |
| HORIZON BCBS BRAVEN | MEDICARE ADVANTAGE | $6,465.11 | ↑ +0% |
| WELLCARE | MANAGED MEDICAID | $6,465.11 | ↑ +0% |
| VACCN | ALL PRODUCTS | $6,465.11 | ↑ +0% |
| WELLCARE | MEDICARE ADVANTAGE | $6,465.11 | ↑ +0% |
| UNITED COMMUNITY/AMERICHOICE | MEDICARE ADVANTAGE | $6,788.36 | ↑ +5% |
| AETNA | MEDICARE ADVANTAGE | $7,046.97 | ↑ +9% |
| HORIZON | OMNIA | $7,049.00 | ↑ +9% |
| UNITED HEALTHCARE | DSNP | $7,758.13 | ↑ +20% |
| HORIZON | SHP | $7,963.00 | ↑ +23% |
| HORIZON | INDEMNITY | $8,703.00 | ↑ +35% |
| HORIZON | HMO | $8,706.00 | ↑ +35% |
| HORIZON | PPO | $8,936.00 | ↑ +38% |
| AETNA | HMO | $9,383.00 | ↑ +45% |
| AETNA | PPO | $9,383.00 | ↑ +45% |
| BRIGHTON HEALTH PLAN | ALL PRODUCTS | $9,933.00 | ↑ +54% |
| QUALCARE | WORKERS COMP | $10,197.00 | ↑ +58% |
| QUALCARE | PPO | $10,197.00 | ↑ +58% |
| HORIZON | PIP | $10,426.42 | ↑ +61% |
| HORIZON | WORKERS COMP | $10,761.15 | ↑ +66% |
| BERGEN RISK | ALL PRODUCTS | $12,012.00 | ↑ +86% |
| AETNA | ASA | $12,540.53 | ↑ +94% |
| CIGNA | BH | $12,812.80 | ↑ +98% |
| MULTIPLAN - PHCS | ALL PRODUCTS | $13,613.60 | ↑ +111% |
| AMERIHEALTH | LOCAL HMO | $13,908.29 | ↑ +115% |
| OXFORD | ALL PRODUCTS | $15,728.00 | ↑ +143% |
| AMERIHEALTH | REGIONAL HMO | $15,753.34 | ↑ +144% |
| UNITED HEALTHCARE | HMO | $19,696.00 | ↑ +205% |
| AMERIGROUP | MANAGED MEDICAID | not published by hospital | — |
Visitor-reported prices
Comments
Lengthening of palate+pharyngeal flap 42226 at other New-jersey hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| Trinitas Regional Medical Center | Elizabeth | $5,855.00 | $467.09 – $12,930.22 |
| Cooperman Barnabas Medical Center | Livingston | $6,839.00 | $722.60 – $13,273.80 |
| Community Medical Center | Toms River | $3,786.00 | $740.01 – $12,865.57 |
| Clara Maass Medical Center | Belleville | $3,986.00 | $713.89 – $13,207.43 |
| Newark Beth Israel Medical Center | Newark | $4,881.00 | $480.83 – $13,273.80 |
| Jersey City Medical Center | Jersey City | $5,339.00 | $604.47 – $13,863.61 |
| Monmouth Medical Center | Long Branch | $5,419.00 | $1,427.78 – $13,030.14 |
| Bayshore Medical Center | Holmdel | $6,547.81 | $6,547.81 – $7,857.37 |