healthcosts.net
Bx nasopharynx/unknown pri lesion 42806 at mercy hospital
1320 Mercy Drive Northwest, Canton, OH · Cleveland Clinic · · NPI 1366433195
$423.80
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.
$652.00
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.
$1.10 with Zing Health vs $5,497.86 with MMO — 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 |
|---|---|---|---|
| Zing Health | Medicare Advantage | $1.10 | ↓ -100% |
| Summacare | Preferred | $86.00 | ↓ -80% |
| Summacare | Medicare Advantage Lower Level | $86.00 | ↓ -80% |
| Summacare | Medicare Advantage Psych | $92.51 | ↓ -78% |
| United | Managed Medicaid | $92.57 | ↓ -78% |
| Caresource | Managed Medicaid | $95.35 | ↓ -78% |
| Buckeye | Managed Medicaid | $97.20 | ↓ -77% |
| AmeriHealth | Managed Medicaid | $101.83 | ↓ -76% |
| Molina | Managed Medicaid | $101.83 | ↓ -76% |
| Summacare | Medicare Advantage CNA | $112.46 | ↓ -73% |
| Anthem | Medicare Advantage | $123.34 | ↓ -71% |
| United | Medicare Advantage | $123.34 | ↓ -71% |
| Humana | Medicare Advantage HMO | $123.34 | ↓ -71% |
| Aetna | Medicare Advantage | $123.34 | ↓ -71% |
| The Health Plan | Medicare Advantage | $123.34 | ↓ -71% |
| Cigna | Medicare Advantage | $123.34 | ↓ -71% |
| Summacare | Medicare Advantage MD | $125.69 | ↓ -70% |
| MMO | Medicare HMO & PPO | $127.04 | ↓ -70% |
| Summacare | Premier | $129.51 | ↓ -69% |
| CommuniCare | Medicare Advantage | $129.51 | ↓ -69% |
| Perennial Health | Medicare Advantage | $133.21 | ↓ -69% |
| The Health Plan | All Products PCP | $135.67 | ↓ -68% |
| The Health Plan | All Products Specialty Physicians | $141.84 | ↓ -67% |
| The Health Plan | All Products Radiation Oncology Physicians | $160.34 | ↓ -62% |
| Oscar | All Products | $165.67 | ↓ -61% |
| Aultcare | PPO/HMO | $233.42 | ↓ -45% |
| OHCP | All Products | $253.63 | ↓ -40% |
| Cigna | All Products Mid-Level | $293.87 | ↓ -31% |
| Aetna | Acop | $300.30 | ↓ -29% |
| Anthem | All Products Mid-Level Non-Facility | $314.30 | ↓ -26% |
| OMAS | All Products | $326.00 | ↓ -23% |
| Cigna | All Products Physician | $347.23 | ↓ -18% |
| PHPHI | All Products | $391.20 | ↓ -8% |
| GMS | All Products | $456.40 | ↑ +8% |
| MMO | Traditional | $456.40 | ↑ +8% |
| Immergrun | All Products | $489.00 | ↑ +15% |
| Aetna | All Products First Health | $489.00 | ↑ +15% |
| United | All Products - Mid-Level | $520.67 | ↑ +23% |
| Aetna | Asa | $521.60 | ↑ +23% |
| United | HMO & PPO | $578.52 | ↑ +37% |
| United | All Products | $578.52 | ↑ +37% |
| Multiplan | All Products | $586.80 | ↑ +38% |
| Aetna | Qhp/Ifp | $652.00 | ↑ +54% |
| UNITED | Managed Medicaid | $766.14 | ↑ +81% |
| CARESOURCE | Managed Medicaid | $789.12 | ↑ +86% |
| ANTHEM | Managed Medicaid | $804.45 | ↑ +90% |
| MOLINA | Managed Medicaid | $804.45 | ↑ +90% |
| AMERIHEALTH | Managed Medicaid | $842.75 | ↑ +99% |
| The Health Plan | MEDICARE ADVANTAGE | $2,696.88 | ↑ +536% |
| UNITED | MEDICARE ADVANTAGE | $2,996.53 | ↑ +607% |
| HUMANA | Medicare Advantage HMO | $2,996.53 | ↑ +607% |
| Summacare | MEDICARE ADVANTAGE | $3,136.68 | ↑ +640% |
| ANTHEM | MEDICARE ADVANTAGE | $3,136.68 | ↑ +640% |
| AETNA | MEDICARE ADVANTAGE | $3,136.68 | ↑ +640% |
| CIGNA | MEDICARE ADVANTAGE | $3,230.78 | ↑ +662% |
| Perennial Health | MEDICARE ADVANTAGE | $3,236.25 | ↑ +664% |
| CommuniCare | MEDICARE ADVANTAGE | $3,293.51 | ↑ +677% |
| Perennial Health | HMO I-SNP and HMO C-SNP | $3,387.61 | ↑ +699% |
| MMO | ALL PRODUCTS | $4,872.30 | ↑ +1050% |
| MMO | SuperMed | $5,497.86 | ↑ +1197% |
| Aetna | ALL PRODUCTS | not published by hospital | — |
Visitor-reported prices
Comments
Bx nasopharynx/unknown pri lesion 42806 at other Ohio hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| cleveland clinic main campus | Cleveland | $423.80 | $1.10 – $3,136.68 |
| akron general | Akron | $423.80 | $1.10 – $3,236.25 |
| avon hospital | Avon | not published | $799.91 – $3,450.35 |
| cleveland clinic childrens hospital for rehabilitation | Cleveland | not published | $1,305.97 – $1,512.17 |
| euclid hospital | Euclid | not published | $819.53 – $3,450.35 |
| fairview hospital | Cleveland | not published | $769.90 – $3,450.35 |
| lutheran hospital | Cleveland | not published | $732.97 – $3,450.35 |
| hillcrest hospital | Mayfield Heights | not published | $802.12 – $3,450.35 |