healthcosts.net
Biopsy of salivary gland 42400 at lodi hospital
225 Elyria Street, Lodi, OH · Cleveland Clinic · · NPI 1801807870
$1,882.40
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.
$2,896.00
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.
$703.59 with OPTUM vs $2,896.00 with AETNA — 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 |
|---|---|---|---|
| OPTUM | All Products VA | $703.59 | ↓ -63% |
| OPTUM | Medicare Advantage Transplant | $703.59 | ↓ -63% |
| ANTHEM | MEDICARE ADVANTAGE | $723.47 | ↓ -62% |
| OSCAR | ALL PRODUCTS | $818.99 | ↓ -56% |
| HUMANA | Medicare Advantage HMO | $868.80 | ↓ -54% |
| UNITED | MEDICARE ADVANTAGE | $868.80 | ↓ -54% |
| MMO | Medicare Advantage HMO & PPO | $868.80 | ↓ -54% |
| AETNA | MEDICARE ADVANTAGE | $926.72 | ↓ -51% |
| PHPHI | ALL PRODUCTS | $926.72 | ↓ -51% |
| PHP | ALL PRODUCTS | $926.72 | ↓ -51% |
| Summacare | MEDICARE ADVANTAGE | $926.72 | ↓ -51% |
| The Health Plan | Secure Care | $1,158.40 | ↓ -38% |
| Amish Community Aid Plan | ALL PRODUCTS | $1,303.20 | ↓ -31% |
| OPTUM | Managed Medicaid Transplant | $1,358.50 | ↓ -28% |
| Aultcare | PPO/HMO | $1,392.98 | ↓ -26% |
| OHCP | ALL PRODUCTS | $1,407.46 | ↓ -25% |
| CARESOURCE | Managed Medicaid | $1,430.00 | ↓ -24% |
| Buckeye | Managed Medicaid | $1,430.00 | ↓ -24% |
| OMAS | ALL PRODUCTS | $1,448.00 | ↓ -23% |
| MOLINA | Managed Medicaid | $1,501.50 | ↓ -20% |
| ANTHEM | Managed Medicaid | $1,501.50 | ↓ -20% |
| UNITED | Managed Medicaid | $1,501.50 | ↓ -20% |
| MMO | TRADITIONAL | $1,508.82 | ↓ -20% |
| Ohio Healthy | TRANSPLANT | $1,563.84 | ↓ -17% |
| AMERIHEALTH | Managed Medicaid | $1,573.00 | ↓ -16% |
| ANTHEM | HPN | $1,581.22 | ↓ -16% |
| OPTUM | All Products Transplant | $1,639.14 | ↓ -13% |
| AETNA | Acop | $1,644.93 | ↓ -13% |
| Summacare | Preferred | $1,668.10 | ↓ -11% |
| UPMC | ALL PRODUCTS | $1,737.60 | ↓ -8% |
| Summacare | PREMIER | $1,812.90 | ↓ -4% |
| CIGNA | ALL PRODUCTS | $1,838.96 | ↓ -2% |
| ANTHEM | PPO/HMO | $1,860.39 | ↓ -1% |
| ANTHEM | TRADITIONAL | $1,918.31 | ↑ +2% |
| CC EHP | ALL PRODUCTS | $1,946.11 | ↑ +3% |
| AETNA | Asa_Whirlpool_Peia | $1,989.55 | ↑ +6% |
| UNITED | ALL PRODUCTS | $2,004.03 | ↑ +6% |
| AETNA | International | $2,009.82 | ↑ +7% |
| GMS | ALL PRODUCTS | $2,027.20 | ↑ +8% |
| Medical Benefit Corp | Transplant SMCP | $2,027.20 | ↑ +8% |
| AETNA | ALL PRODUCTS | $2,172.00 | ↑ +15% |
| Consociate Health | ALL PRODUCTS | $2,172.00 | ↑ +15% |
| The Health Plan | ALL PRODUCTS | $2,316.80 | ↑ +23% |
| FrontPath | TRANSPLANT | $2,606.40 | ↑ +38% |
| Managed Care Services | TRANSPLANT | $2,606.40 | ↑ +38% |
| MULTIPLAN | ALL PRODUCTS | $2,606.40 | ↑ +38% |
| Tertiary Care Network | TRANSPLANT | $2,606.40 | ↑ +38% |
| AETNA | Qhp/Ipf | $2,896.00 | ↑ +54% |
| AETNA | NAP | not published by hospital | — |
| CIGNA | MEDICARE ADVANTAGE | not published by hospital | — |
| CommuniCare | MEDICARE ADVANTAGE | not published by hospital | — |
Visitor-reported prices
Comments
Biopsy of salivary gland 42400 at other Ohio hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| cleveland clinic main campus | Cleveland | $2,104.05 | $0.01 – $2,913.30 |
| akron general | Akron | $2,104.05 | $0.01 – $2,606.40 |
| avon hospital | Avon | $2,104.05 | $0.01 – $2,913.30 |
| euclid hospital | Euclid | $2,104.05 | $0.01 – $2,913.30 |
| fairview hospital | Cleveland | $2,104.05 | $0.01 – $2,913.30 |
| lutheran hospital | Cleveland | $2,104.05 | $0.01 – $2,913.30 |
| hillcrest hospital | Mayfield Heights | $2,104.05 | $0.01 – $2,913.30 |
| marymount hospital | Garfield Heights | $2,104.05 | $0.01 – $2,913.30 |