healthcosts.net
Total Knee Replacement at UnityPoint Health - Meriter Hospital
202 South Park Street, Madison, WI · UnityPoint Health · · NPI 1114920048
$20,313.60
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.
$25,392.00
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.
$1,150.22 with Anthem Blue Cross and Blue Shield vs $16,081.60 with Anthem Blue Cross and Blue Shield — 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 |
|---|---|---|---|
| Anthem Blue Cross and Blue Shield | Medicare Advantage | $1,150.22 | ↓ -94% |
| Aspirus | Medicare Advantage | $1,150.22 | ↓ -94% |
| IlliniCare | Medicare Advantage | $1,150.22 | ↓ -94% |
| Prevea 360 | Medicare Advantage | $1,150.22 | ↓ -94% |
| United Healthcare | Medicare Advantage | $1,150.22 | ↓ -94% |
| Humana | Medicare Advantage | $1,207.73 | ↓ -94% |
| MeridianCare | Medicare Advantage | $1,207.73 | ↓ -94% |
| Health Partners Open Network | Commercial | $2,631.60 | ↓ -87% |
| United Healthcare | Commercial | $2,967.31 | ↓ -85% |
| Anthem Blue Cross and Blue Shield | Blue Priority/Pathway | $3,519.67 | ↓ -83% |
| Medical Associates Health Plan | HMO/POS/PPO | $3,818.73 | ↓ -81% |
| Anthem Blue Cross and Blue Shield | HMO/POS | $3,841.73 | ↓ -81% |
| Anthem Blue Cross and Blue Shield | PPO | $3,841.73 | ↓ -81% |
| Wellmark UPH Self-Funded | Commercial | $3,841.73 | ↓ -81% |
| Aspirus | PPO | $3,893.44 | ↓ -81% |
| Cigna | Commercial | $4,739.84 | ↓ -77% |
| Security Health Plan | HMO/POS/SAS | $5,078.40 | ↓ -75% |
| Aspirus | HMO/POS | $5,924.80 | ↓ -71% |
| Mercy Care | HMO/POS | $5,924.80 | ↓ -71% |
| Prevea 360 | Commercial | $14,388.80 | ↓ -29% |
| Anthem Blue Cross and Blue Shield | Traditional | $16,081.60 | ↓ -21% |
| United Healthcare | Managed Medicaid | not published by hospital | — |
| Quartz | HMO | not published by hospital | — |
| My Choice | Managed Medicaid | not published by hospital | — |
| GHC - South Central WI | Managed Medicaid | not published by hospital | — |
| GHC - Eau Claire | Managed Medicaid | not published by hospital | — |
| GHC | HMO | not published by hospital | — |
| Dean Health Plan | Managed Medicaid | not published by hospital | — |
| Anthem Blue Cross and Blue Shield | Managed Medicaid | not published by hospital | — |