Application long leg splint 29505 at SSM Health St. Agnes Hospital - Fond du Lac

430 E Division St, Fond Du Lac, WI · SSM Health · · NPI 1346228541

Source: hospital's published price file ↗ · Published Apr 1, 2026 · Ingested Sep 10, 2026

$314.60

Cash price

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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.

$572.00

Gross charge

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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.

Full explanation →

The hospital's undiscounted list price — almost no one pays this.

$120.55 with MOLINA vs $3,335.00 with BCBS — 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 →

Payer
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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
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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
MOLINA Medicare Managed Care Plan $120.55 ↓ -62%
BCBS Anthem Medicare Managed Care Plan $160.73 ↓ -49%
Wellcare Medicare Managed Care Plan $163.95 ↓ -48%
DOC Government $310.21 ↓ -1%
Centivo Broad(WI1) Other Commercial Plan $1,887.00 ↑ +500%
Centivo Median(WI2) Other Commercial Plan $1,887.00 ↑ +500%
Centivo Value(WI3) Other Commercial Plan $1,887.00 ↑ +500%
Network Health Plan HMO/POS $2,334.00 ↑ +642%
BCBS Blue Preferred / Blue Preferred Plus HMO/POS $2,654.00 ↑ +744%
BCBS Blue Traditional Traditional $3,335.00 ↑ +960%
BCBS Blue Access PPO $3,335.00 ↑ +960%

Visitor-reported prices

visitor-reported
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Application long leg splint 29505 at other Wisconsin hospitals

Hospital City Cash price Negotiated range
Ascension Columbia St. Mary's Hospital - Ozaukee Campus (Columbia St. Mary's Hospital Milwaukee, Inc.) Mequon $63.07 $82.42 – $337.94
UnityPoint Health - Meriter Hospital Madison $477.58 $17.02 – $186.25
SSM Health St. Clare Hospital - Baraboo Baraboo $332.75 $118.38 – $4,401.00
SSM Health St. Mary's Hospital - Janesville Janesville $455.95 $122.76 – $4,074.00
SSM Health St. Mary's Hospital - Madison Madison $448.80 $118.38 – $4,198.00
SSM Health Monroe Hospital Monroe $114.40 $157.84 – $4,217.00
SSM Health Ripon Community Hospital Ripon $314.60 $1,887.00 – $2,654.00
SSM Health Waupun Memorial Hospital Waupun $314.60 $1,887.00 – $2,654.00

All Wisconsin hospitals for this procedure →