healthcosts.net
Exc breast duct fistula 19112 at mercy hospital
1320 Mercy Drive Northwest, Canton, OH · Cleveland Clinic · · NPI 1366433195
$990.60
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.
$1,524.00
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 $6,508.54 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% |
| United | Managed Medicaid | $166.63 | ↓ -83% |
| Caresource | Managed Medicaid | $171.63 | ↓ -83% |
| Buckeye | Managed Medicaid | $174.96 | ↓ -82% |
| AmeriHealth | Managed Medicaid | $183.29 | ↓ -81% |
| Molina | Managed Medicaid | $183.29 | ↓ -81% |
| Summacare | Preferred | $199.65 | ↓ -80% |
| Summacare | Medicare Advantage Lower Level | $199.65 | ↓ -80% |
| Summacare | Medicare Advantage Psych | $238.33 | ↓ -76% |
| Summacare | Medicare Advantage CNA | $261.08 | ↓ -74% |
| Summacare | Medicare Advantage MD | $291.79 | ↓ -71% |
| The Health Plan | Medicare Advantage | $317.77 | ↓ -68% |
| Anthem | Medicare Advantage | $317.77 | ↓ -68% |
| United | Medicare Advantage | $317.77 | ↓ -68% |
| Aetna | Medicare Advantage | $317.77 | ↓ -68% |
| Humana | Medicare Advantage HMO | $317.77 | ↓ -68% |
| Cigna | Medicare Advantage | $317.77 | ↓ -68% |
| MMO | Medicare HMO & PPO | $327.30 | ↓ -67% |
| CommuniCare | Medicare Advantage | $333.66 | ↓ -66% |
| Summacare | Premier | $333.66 | ↓ -66% |
| Perennial Health | Medicare Advantage | $343.19 | ↓ -65% |
| The Health Plan | All Products PCP | $349.55 | ↓ -65% |
| The Health Plan | All Products Specialty Physicians | $365.44 | ↓ -63% |
| Oscar | All Products | $387.25 | ↓ -61% |
| The Health Plan | All Products Radiation Oncology Physicians | $413.10 | ↓ -58% |
| Aultcare | PPO/HMO | $545.59 | ↓ -45% |
| Cigna | All Products Mid-Level | $566.67 | ↓ -43% |
| OHCP | All Products | $592.84 | ↓ -40% |
| Anthem | All Products Mid-Level Non-Facility | $606.07 | ↓ -39% |
| Aetna | Acop | $628.45 | ↓ -37% |
| Cigna | All Products Physician | $669.58 | ↓ -32% |
| OMAS | All Products | $762.00 | ↓ -23% |
| UNITED | Managed Medicaid | $841.30 | ↓ -15% |
| CARESOURCE | Managed Medicaid | $866.54 | ↓ -13% |
| ANTHEM | Managed Medicaid | $883.37 | ↓ -11% |
| MOLINA | Managed Medicaid | $883.37 | ↓ -11% |
| PHPHI | All Products | $914.40 | ↓ -8% |
| AMERIHEALTH | Managed Medicaid | $925.43 | ↓ -7% |
| United | All Products - Mid-Level | $1,004.50 | ↑ +1% |
| GMS | All Products | $1,066.80 | ↑ +8% |
| MMO | Traditional | $1,066.80 | ↑ +8% |
| United | All Products | $1,116.11 | ↑ +13% |
| United | HMO & PPO | $1,116.11 | ↑ +13% |
| Aetna | All Products First Health | $1,143.00 | ↑ +15% |
| Immergrun | All Products | $1,143.00 | ↑ +15% |
| Aetna | Asa | $1,219.20 | ↑ +23% |
| Multiplan | All Products | $1,371.60 | ↑ +38% |
| Aetna | Qhp/Ifp | $1,524.00 | ↑ +54% |
| The Health Plan | MEDICARE ADVANTAGE | $3,184.36 | ↑ +221% |
| HUMANA | Medicare Advantage HMO | $3,538.18 | ↑ +257% |
| UNITED | MEDICARE ADVANTAGE | $3,538.18 | ↑ +257% |
| AETNA | MEDICARE ADVANTAGE | $3,704.30 | ↑ +274% |
| Summacare | MEDICARE ADVANTAGE | $3,704.30 | ↑ +274% |
| ANTHEM | MEDICARE ADVANTAGE | $3,704.30 | ↑ +274% |
| CIGNA | MEDICARE ADVANTAGE | $3,815.43 | ↑ +285% |
| Perennial Health | MEDICARE ADVANTAGE | $3,821.23 | ↑ +286% |
| CommuniCare | MEDICARE ADVANTAGE | $3,889.52 | ↑ +293% |
| Perennial Health | HMO I-SNP and HMO C-SNP | $4,000.65 | ↑ +304% |
| MMO | ALL PRODUCTS | $5,768.37 | ↑ +482% |
| MMO | SuperMed | $6,508.54 | ↑ +557% |
| Aetna | ALL PRODUCTS | not published by hospital | — |
Visitor-reported prices
Comments
Exc breast duct fistula 19112 at other Ohio hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| cleveland clinic main campus | Cleveland | $990.60 | $1.10 – $3,704.30 |
| akron general | Akron | $990.60 | $1.10 – $3,821.23 |
| avon hospital | Avon | not published | $878.38 – $4,074.73 |
| cleveland clinic childrens hospital for rehabilitation | Cleveland | not published | $1,434.07 – $1,660.51 |
| euclid hospital | Euclid | not published | $899.92 – $4,074.73 |
| fairview hospital | Cleveland | not published | $845.42 – $4,074.73 |
| lutheran hospital | Cleveland | not published | $804.88 – $4,074.73 |
| hillcrest hospital | Mayfield Heights | not published | $880.80 – $4,074.73 |