Lidocaine (pf) 4 mg/ml (0.4 %) in 5 % dextrose intravenous solution at HSHS St. Mary's Hospital Medical Center

1726 SHAWANO AVE, GREEN BAY, WI · Hshs · · NPI 1649246877

Source: hospital's published price file ↗ · Published Mar 24, 2026 · Ingested Sep 16, 2026

$4.10

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.

$6.21

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.

$0.02 with UNITED HEALTHCARE vs $6.21 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 →

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
UNITED HEALTHCARE ALL COMMERCIAL UNITED HEALTHCARE $0.02 ↓ -100%
UNITED HEALTHCARE UHC ONEIDA NATION $0.02 ↓ -100%
UNITED HEALTHCARE UNITED HEALTHCARE $0.02 ↓ -100%
HSHS EMPLOYEES HSHS EMPLOYEES $3.02 ↓ -26%
MOLINA HEALTHCARE OF WI ALL COMMERICAL MOLINA MARKETPLACE $3.11 ↓ -24%
WISCONSIN PHYSICIAN SERVICE WISCONSIN PHYSICIAN SERVICE $3.73 ↓ -9%
WEA PROVIDER NETWORK WEA INSURANCE CORPORATION PPP $3.85 ↓ -6%
HUMANA HUMANA NATIIONAL POS HMO $3.94 ↓ -4%
HUMANA HUMANA CHOICE CARE HMO $3.94 ↓ -4%
SECURITY HEALTH PLAN ALL COMMERCIAL SECURITY HEALTH PLAN BROAD NETWORK $3.96 ↓ -3%
CIGNA ALL COMMERCIAL CIGNA $4.35 ↑ +6%
HEALTH EOS ALL COMMERCIAL HEALTH EOS $4.41 ↑ +8%
TRIOLOGY ALL COMMERCIAL TRIOLOGY $4.47 ↑ +9%
WEA PROVIDER NETWORK WEA INSURANCE CORPORATION $4.47 ↑ +9%
WEA PROVIDER NETWORK WEA INSURANCE CORPORATION TRUST SELECT $4.47 ↑ +9%
WEA PROVIDER NETWORK WEA TRUST PPP/TRUST PREFERRED $4.47 ↑ +9%
HEALTHSMART ALL COMMERCIAL HEALTHSMART $4.53 ↑ +10%
INTERPLAN ALL COMMERCIAL INTERPLAN HEALTH GROUP $4.53 ↑ +10%
NETWORK HEALTH PLAN ALL COMMERICAL NETWORK HEALTH PLAN $4.66 ↑ +14%
HEALTH CARE ALLIANCE THE ALLIANCE $5.22 ↑ +27%
MULTIPLAN/PHCS ALL COMMERCIAL MULTIPLAN $5.22 ↑ +27%
CHOICECARE ALL COMMERCIAL CHOICE CARE $5.28 ↑ +29%
HUMANA HUMANA CHOICE CARE PPO $5.28 ↑ +29%
HUMANA ALL COMMERCIAL HUMANA HPN CHOICECARE $5.28 ↑ +29%
NORTH CENTRAL HEALTHCARE ALLIANCE NEHA $5.71 ↑ +39%
FIRST HEALTH ALL COMMERCIAL FIRST HEALTH NETWORK $5.90 ↑ +44%
AETNA AETNA HSHS $6.21 ↑ +51%
COFINITY COFINITY $6.21 ↑ +51%
CATERPILLAR, INC. UHC CATERPILLAR EMPLOYER GROUP $6.21 ↑ +51%
LIVE360 LIVE360 HSHS HEALTHY PLAN $6.21 ↑ +51%
CENPATICO ALL MEDICAID CENPATICO $6.21 ↑ +51%
AETNA ALL COMMERCIAL AETNA $6.21 ↑ +51%

Visitor-reported prices

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Lidocaine (pf) 4 mg/ml (0.4 %) in 5 % dextrose intravenous solution at other Wisconsin hospitals

Hospital City Cash price Negotiated range
Aurora Baycare Medical Center Green Bay not published $0.01 – $0.02
SSM Health St. Clare Hospital - Baraboo Baraboo not published $0.01 – $0.02
SSM Health St. Mary's Hospital - Janesville Janesville not published $0.01 – $0.02
SSM Health St. Mary's Hospital - Madison Madison not published $0.01 – $0.02
SSM Health Monroe Hospital Monroe not published $0.01 – $0.03
SSM Health Ripon Community Hospital Ripon not published $0.01 – $0.03
SSM Health St. Agnes Hospital - Fond du Lac Fond Du Lac not published $0.01 – $0.03
SSM Health Waupun Memorial Hospital Waupun not published $0.01 – $0.03

All Wisconsin hospitals for this procedure →