Treatment of mouth lesion physical 40820 at UnityPoint Health - Meriter Hospital
202 South Park Street, Madison, WI · UnityPoint Health · · NPI 1114920048
$1,676.00
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.
?
What you pay up front if you don't use insurance.
$2,095.00
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.
?
The hospital's undiscounted list price — almost no one pays this.
$152.68 with Prevea 360 vs $795.15 with Anthem Blue Cross and Blue Shield — same scan, same building. Share
Negotiated rates by payer
?
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 →
?
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 |
|---|---|---|---|
| Prevea 360 | Medicare Advantage | $152.68 | ↓ -91% |
| United Healthcare | Medicare Advantage | $152.68 | ↓ -91% |
| IlliniCare | Medicare Advantage | $152.68 | ↓ -91% |
| Anthem Blue Cross and Blue Shield | Medicare Advantage | $152.68 | ↓ -91% |
| Aspirus | Medicare Advantage | $152.68 | ↓ -91% |
| Humana | Medicare Advantage | $160.31 | ↓ -90% |
| MeridianCare | Medicare Advantage | $160.31 | ↓ -90% |
| Aspirus | PPO | $192.51 | ↓ -89% |
| Cigna | Commercial | $234.36 | ↓ -86% |
| Security Health Plan | HMO/POS/SAS | $251.10 | ↓ -85% |
| Aspirus | HMO/POS | $292.95 | ↓ -83% |
| Mercy Care | HMO/POS | $292.95 | ↓ -83% |
| Health Partners Open Network | Commercial | $321.97 | ↓ -81% |
| United Healthcare | Commercial | $376.43 | ↓ -78% |
| Anthem Blue Cross and Blue Shield | Blue Priority/Pathway | $467.20 | ↓ -72% |
| Medical Associates Health Plan | HMO/POS/PPO | $506.90 | ↓ -70% |
| Wellmark UPH Self-Funded | Commercial | $509.95 | ↓ -70% |
| Anthem Blue Cross and Blue Shield | HMO/POS | $509.95 | ↓ -70% |
| Anthem Blue Cross and Blue Shield | PPO | $509.95 | ↓ -70% |
| Prevea 360 | Commercial | $711.45 | ↓ -58% |
| Anthem Blue Cross and Blue Shield | Traditional | $795.15 | ↓ -53% |
| My Choice | Managed Medicaid | not published by hospital | — |
| GHC - South Central WI | Managed Medicaid | not published by hospital | — |
| Quartz | 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 | — |
| United Healthcare | Managed Medicaid | not published by hospital | — |
| GHC | HMO | not published by hospital | — |
| GHC - Eau Claire | Managed Medicaid | not published by hospital | — |
Visitor-reported prices
Comments
Treatment of mouth lesion physical 40820 at other Wisconsin hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| SSM Health St. Mary's Hospital - Madison | Madison | not published | $2,415.31 – $4,982.00 |
| Ascension Columbia St. Mary's Hospital - Ozaukee Campus (Columbia St. Mary's Hospital Milwaukee, Inc.) | Mequon | $235.85 | $271.27 – $1,039.97 |
| Ascension Columbia St. Mary's Hospital - Milwaukee Campus (Columbia St. Mary's Hospital Milwaukee, Inc.) | Milwaukee | not published | $271.27 – $1,039.97 |
| Orthopaedic Hospital of Wisconsin, LLC | Glendale | not published | $1,549.00 – $16,897.00 |
| SSM Health St. Clare Hospital - Baraboo | Baraboo | not published | $2,415.31 – $4,867.00 |
| SSM Health St. Mary's Hospital - Janesville | Janesville | not published | $2,504.63 – $4,321.00 |
| SSM Health Monroe Hospital | Monroe | not published | $3,220.41 – $4,743.00 |
| SSM Health Ripon Community Hospital | Ripon | not published | $3,388.00 – $4,761.00 |