Clsd tx metatarsal fracture w/manip 28475 at SSM Health St. Agnes Hospital - Fond du Lac
430 E Division St, Fond Du Lac, WI · SSM Health · · NPI 1346228541
$374.00
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.
$680.00
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.
$182.99 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 →
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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 |
|---|---|---|---|
| MOLINA | Medicare Managed Care Plan | $182.99 | ↓ -51% |
| BCBS | Anthem Medicare Managed Care Plan | $243.98 | ↓ -35% |
| Wellcare | Medicare Managed Care Plan | $248.86 | ↓ -33% |
| DOC | Government | $470.88 | ↑ +26% |
| Centivo | Broad(WI1) Other Commercial Plan | $1,887.00 | ↑ +405% |
| Centivo | Median(WI2) Other Commercial Plan | $1,887.00 | ↑ +405% |
| Centivo | Value(WI3) Other Commercial Plan | $1,887.00 | ↑ +405% |
| Network Health Plan | HMO/POS | $2,334.00 | ↑ +524% |
| BCBS | Blue Preferred / Blue Preferred Plus HMO/POS | $2,654.00 | ↑ +610% |
| BCBS | Blue Traditional Traditional | $3,335.00 | ↑ +792% |
| BCBS | Blue Access PPO | $3,335.00 | ↑ +792% |
Visitor-reported prices
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Clsd tx metatarsal fracture w/manip 28475 at other Wisconsin hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UnityPoint Health - Meriter Hospital | Madison | $1,200.80 | $138.00 – $397.05 |
| SSM Health Monroe Hospital | Monroe | $672.65 | $239.60 – $4,217.00 |
| SSM Health Ripon Community Hospital | Ripon | $374.00 | $1,887.00 – $2,654.00 |
| SSM Health Waupun Memorial Hospital | Waupun | $374.00 | $1,887.00 – $2,654.00 |
| Ascension Columbia St. Mary's Hospital - Milwaukee Campus (Columbia St. Mary's Hospital Milwaukee, Inc.) | Milwaukee | not published | $233.52 – $1,023.28 |
| Ascension Columbia St. Mary's Hospital - Ozaukee Campus (Columbia St. Mary's Hospital Milwaukee, Inc.) | Mequon | not published | $233.52 – $1,023.28 |
| Orthopaedic Hospital of Wisconsin, LLC | Glendale | not published | $743.00 – $16,897.00 |
| SSM Health St. Clare Hospital - Baraboo | Baraboo | not published | $179.70 – $4,401.00 |