healthcosts.net
Established Patient Office Visit (level 5) at Sanford Vermillion Hospital
20 S Plum St, Vermillion, SD · Sanford Health · · NPI 1790721280
$322.40
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.
$403.00
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.
$118.89 with Sanford Health Plan Align vs $362.70 with Multiplan — 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 |
|---|---|---|---|
| Sanford Health Plan Align | Medicare Replacement | $118.89 | ↓ -63% |
| Wellmark SD | Medicare Replacement | $122.51 | ↓ -62% |
| Ucare | Medicare Replacement | $131.38 | ↓ -59% |
| Aetna | Medicare Replacement | $132.99 | ↓ -59% |
| Great Plains Medicare Advantage | Medicare Replacement | $132.99 | ↓ -59% |
| Health Partners | Medicare Replacement | $132.99 | ↓ -59% |
| United Healthcare | Medicare Replacement | $132.99 | ↓ -59% |
| Primewest | Medicare Replacement | $135.41 | ↓ -58% |
| Sanford Health Plan | SD Exchange True | $159.55 | ↓ -51% |
| Sanford Health Plan | Group Health/True | $181.91 | ↓ -44% |
| Sanford Health Plan | SD Exchange Commercial | $187.72 | ↓ -42% |
| Sanford Health Plan | Commercial/ND Pers | $214.03 | ↓ -34% |
| Security Health Plan | Commercial | $221.65 | ↓ -31% |
| Health Partners | State Employees | $265.98 | ↓ -18% |
| Health Partners | Commercial | $302.25 | ↓ -6% |
| Medica | Choice | $332.48 | ↑ +3% |
| United Healthcare | Commercial +20 | $336.51 | ↑ +4% |
| Wellmark | PPO | $346.58 | ↑ +8% |
| Aetna | Commercial | $350.21 | ↑ +9% |
| Ucare | Commercial | $354.08 | ↑ +10% |
| Medica | Elect | $355.45 | ↑ +10% |
| First Choice Health Network | Commercial | $362.70 | ↑ +13% |
| Healthez | Commercial | $362.70 | ↑ +13% |
| Multiplan | Commercial | $362.70 | ↑ +13% |
Visitor-reported prices
Comments
Established Patient Office Visit (level 5) at other South-dakota hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| Sanford Clear Lake Medical Center | Clear Lake | $327.20 | $146.72 – $257.40 |
| Sanford USD Medical Center | Sioux Falls | $1,095.20 | $66.92 – $227.70 |
| Sanford Aberdeen Medical Center | Aberdeen | $306.40 | $162.87 – $344.70 |