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Excision of mouth lesion complex 40816 at mercy hospital
1320 Mercy Drive Northwest, Canton, OH · Cleveland Clinic · · NPI 1366433195
$980.20
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.
$1,508.00
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 | $185.10 | ↓ -81% |
| Summacare | Medicare Advantage Lower Level | $185.10 | ↓ -81% |
| Summacare | Medicare Advantage Psych | $201.85 | ↓ -79% |
| United | Managed Medicaid | $207.53 | ↓ -79% |
| Caresource | Managed Medicaid | $213.76 | ↓ -78% |
| Buckeye | Managed Medicaid | $217.91 | ↓ -78% |
| AmeriHealth | Managed Medicaid | $228.28 | ↓ -77% |
| Molina | Managed Medicaid | $228.28 | ↓ -77% |
| Summacare | Medicare Advantage CNA | $242.05 | ↓ -75% |
| Anthem | Medicare Advantage | $269.13 | ↓ -73% |
| United | Medicare Advantage | $269.13 | ↓ -73% |
| Aetna | Medicare Advantage | $269.13 | ↓ -73% |
| Humana | Medicare Advantage HMO | $269.13 | ↓ -73% |
| The Health Plan | Medicare Advantage | $269.13 | ↓ -73% |
| Cigna | Medicare Advantage | $269.13 | ↓ -73% |
| Summacare | Medicare Advantage MD | $270.53 | ↓ -72% |
| MMO | Medicare HMO & PPO | $277.20 | ↓ -72% |
| CommuniCare | Medicare Advantage | $282.59 | ↓ -71% |
| Summacare | Premier | $282.59 | ↓ -71% |
| Perennial Health | Medicare Advantage | $290.66 | ↓ -70% |
| The Health Plan | All Products PCP | $296.04 | ↓ -70% |
| The Health Plan | All Products Specialty Physicians | $309.50 | ↓ -68% |
| The Health Plan | All Products Radiation Oncology Physicians | $349.87 | ↓ -64% |
| Oscar | All Products | $383.18 | ↓ -61% |
| Cigna | All Products Mid-Level | $492.44 | ↓ -50% |
| Anthem | All Products Mid-Level Non-Facility | $526.68 | ↓ -46% |
| Aultcare | PPO/HMO | $539.86 | ↓ -45% |
| Aetna | Acop | $552.33 | ↓ -44% |
| Cigna | All Products Physician | $581.87 | ↓ -41% |
| OHCP | All Products | $586.61 | ↓ -40% |
| OMAS | All Products | $754.00 | ↓ -23% |
| United | All Products - Mid-Level | $876.30 | ↓ -11% |
| PHPHI | All Products | $904.80 | ↓ -8% |
| United | HMO & PPO | $973.67 | ↓ -1% |
| United | All Products | $973.67 | ↓ -1% |
| MMO | Traditional | $1,055.60 | ↑ +8% |
| GMS | All Products | $1,055.60 | ↑ +8% |
| Immergrun | All Products | $1,131.00 | ↑ +15% |
| Aetna | All Products First Health | $1,131.00 | ↑ +15% |
| Aetna | Asa | $1,206.40 | ↑ +23% |
| Multiplan | All Products | $1,357.20 | ↑ +38% |
| UNITED | Managed Medicaid | $1,430.00 | ↑ +46% |
| CARESOURCE | Managed Medicaid | $1,472.90 | ↑ +50% |
| MOLINA | Managed Medicaid | $1,501.50 | ↑ +53% |
| ANTHEM | Managed Medicaid | $1,501.50 | ↑ +53% |
| Aetna | Qhp/Ifp | $1,508.00 | ↑ +54% |
| AMERIHEALTH | Managed Medicaid | $1,573.00 | ↑ +60% |
| The Health Plan | MEDICARE ADVANTAGE | $2,696.88 | ↑ +175% |
| UNITED | MEDICARE ADVANTAGE | $2,996.53 | ↑ +206% |
| HUMANA | Medicare Advantage HMO | $2,996.53 | ↑ +206% |
| AETNA | MEDICARE ADVANTAGE | $3,136.68 | ↑ +220% |
| Summacare | MEDICARE ADVANTAGE | $3,136.68 | ↑ +220% |
| ANTHEM | MEDICARE ADVANTAGE | $3,136.68 | ↑ +220% |
| CIGNA | MEDICARE ADVANTAGE | $3,230.78 | ↑ +230% |
| Perennial Health | MEDICARE ADVANTAGE | $3,236.25 | ↑ +230% |
| CommuniCare | MEDICARE ADVANTAGE | $3,293.51 | ↑ +236% |
| Perennial Health | HMO I-SNP and HMO C-SNP | $3,387.61 | ↑ +246% |
| MMO | ALL PRODUCTS | $4,872.30 | ↑ +397% |
| MMO | SuperMed | $5,497.86 | ↑ +461% |
| Aetna | ALL PRODUCTS | not published by hospital | — |
Visitor-reported prices
Comments
Excision of mouth lesion complex 40816 at other Ohio hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| cleveland clinic main campus | Cleveland | $980.20 | $1.10 – $3,136.68 |
| akron general | Akron | $980.20 | $1.10 – $3,236.25 |
| avon hospital | Avon | not published | $1,501.50 – $3,450.35 |
| cleveland clinic childrens hospital for rehabilitation | Cleveland | not published | $1,358.50 – $1,573.00 |
| euclid hospital | Euclid | not published | $1,358.50 – $3,450.35 |
| fairview hospital | Cleveland | not published | $1,358.50 – $3,450.35 |
| lutheran hospital | Cleveland | not published | $1,358.50 – $3,450.35 |
| hillcrest hospital | Mayfield Heights | not published | $1,358.50 – $3,450.35 |