Closed tx humerus fx with manip 23605 at SSM Health St. Mary's Hospital - Madison
700 South Park St, Madison, WI · SSM Health · · NPI 1902290034
$1,409.10
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.
$2,562.00
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.
$1,171.42 with Molina vs $8,124.00 with Centivo — 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 | $1,171.42 | ↓ -17% |
| Dean Health Plan | Medicare Managed Care Plan | $1,561.89 | ↑ +11% |
| BCBS | Blue Preferred/Blue Preferred Plus HMO/POS | $4,982.00 | ↑ +254% |
| BCBS | Blue Access PPO | $7,498.00 | ↑ +432% |
| BCBS | Anthem Blue Traditional Traditional | $7,498.00 | ↑ +432% |
| Centivo | Broad(WI2) Other Commercial Plan | $8,124.00 | ↑ +477% |
Visitor-reported prices
Comments
Closed tx humerus fx with manip 23605 at other Wisconsin hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UnityPoint Health - Meriter Hospital | Madison | $8,206.40 | $399.44 – $3,200.49 |
| SSM Health St. Clare Hospital - Baraboo | Baraboo | $1,303.50 | $1,171.42 – $6,687.00 |
| SSM Health St. Mary's Hospital - Janesville | Janesville | $1,272.70 | $1,214.74 – $6,798.00 |
| SSM Health Monroe Hospital | Monroe | $149.05 | $1,561.89 – $8,701.00 |
| Ascension Calumet Hospital, Inc. | Chilton | $3,024.99 | $456.71 – $1,677.49 |
| Ascension Columbia St. Mary's Hospital - Milwaukee Campus (Columbia St. Mary's Hospital Milwaukee, Inc.) | Milwaukee | not published | $692.87 – $1,834.05 |
| Ascension Columbia St. Mary's Hospital - Ozaukee Campus (Columbia St. Mary's Hospital Milwaukee, Inc.) | Mequon | not published | $692.87 – $1,834.05 |
| Orthopaedic Hospital of Wisconsin, LLC | Glendale | not published | $1,549.00 – $16,897.00 |