Aco annual medicare visit (awv), initial g0438aco at HSHS St. Clare Memorial Hospital
855 S MAIN STREET, OCONTO FALLS, WI · Hshs · · NPI 1851477913
$177.54
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.
$269.00
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.
$64.56 with MOLINA HEALTHCARE vs $269.00 with HEALTHSMART — 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 HEALTHCARE | MOLINA MEDICARE | $64.56 | ↓ -64% |
| UNITED HEALTHCARE | UNITED HEALTH CARE MEDICARE | $64.56 | ↓ -64% |
| AETNA | AETNA MEDICARE | $64.56 | ↓ -64% |
| ANTHEM | ANTHEM MEDICARE ADVANTAGE HMO | $64.56 | ↓ -64% |
| HUMANA | HUMANA MEDICARE ADVANTAGE | $64.56 | ↓ -64% |
| SECURITY HEALTH PLAN | MEDICARE ADVANTAGE SECURITY HEALTH PLAN OF WI | $65.21 | ↓ -63% |
| UNITED HEALTHCARE | UHC ONEIDA NATION | $95.40 | ↓ -46% |
| UNITED HEALTHCARE | ALL COMMERCIAL UNITED HEALTHCARE | $95.40 | ↓ -46% |
| UNITED HEALTHCARE | UNITED HEALTHCARE | $95.40 | ↓ -46% |
| HSHS EMPLOYEES | HSHS EMPLOYEES | $130.73 | ↓ -26% |
| MOLINA HEALTHCARE OF WI | ALL COMMERICAL MOLINA MARKETPLACE | $134.50 | ↓ -24% |
| NAPHCARE | ALL COMMERICAL NAPHCARE | $145.26 | ↓ -18% |
| ANTHEM | ANTHEM PPO | $154.00 | ↓ -13% |
| ANTHEM | ANTHEM POS/HMO | $154.00 | ↓ -13% |
| PREVEA HEALTH NETWORK | PREVEA360 | $161.40 | ↓ -9% |
| PREVEA HEALTH NETWORK | PREVEA EMPLOYEES | $161.40 | ↓ -9% |
| P360 SMALL GROUP | PREVEA 360 SMALL GROUP COMMERCIAL PLAN | $161.40 | ↓ -9% |
| PREVEA HEALTH NETWORK | PREVEA360 - NETWORK | $161.40 | ↓ -9% |
| UNITY HEALTH PLAN | UNITY HOSPICE | $166.99 | ↓ -6% |
| CIGNA | ALL COMMERCIAL CIGNA | $168.13 | ↓ -5% |
| SECURITY HEALTH PLAN | ALL COMMERCIAL SECURITY HEALTH PLAN BROAD NETWORK | $171.70 | ↓ -3% |
| TRIOLOGY | ALL COMMERCIAL TRIOLOGY | $212.51 | ↑ +20% |
| ARISE HEALTH PLAN | ALL COMMERCIAL ARISE HEALTH PLAN | $215.20 | ↑ +21% |
| WISCONSIN PHYSICIAN SERVICE | WISCONSIN PHYSICIAN SERVICE | $215.20 | ↑ +21% |
| WEA PROVIDER NETWORK | WEA TRUST PPP/TRUST PREFERRED | $220.58 | ↑ +24% |
| WEA PROVIDER NETWORK | WEA INSURANCE CORPORATION PPP | $220.58 | ↑ +24% |
| HEALTH CARE ALLIANCE | THE ALLIANCE | $225.96 | ↑ +27% |
| HUMANA | ALL COMMERCIAL HUMANA HPN CHOICECARE | $228.65 | ↑ +29% |
| CHOICECARE | ALL COMMERCIAL CHOICE CARE | $228.65 | ↑ +29% |
| HUMANA | HUMANA NATIIONAL POS HMO | $228.65 | ↑ +29% |
| HUMANA | HUMANA CHOICE CARE PPO | $228.65 | ↑ +29% |
| HEALTH EOS | ALL COMMERCIAL HEALTH EOS | $239.41 | ↑ +35% |
| MULTIPLAN/PHCS | ALL COMMERCIAL MULTIPLAN | $239.41 | ↑ +35% |
| NETWORK HEALTH PLAN | ALL COMMERICAL NETWORK HEALTH PLAN | $242.10 | ↑ +36% |
| COFINITY | COFINITY | $242.10 | ↑ +36% |
| INTERPLAN | ALL COMMERCIAL INTERPLAN HEALTH GROUP | $242.10 | ↑ +36% |
| NORTH CENTRAL HEALTHCARE ALLIANCE | NEHA | $247.48 | ↑ +39% |
| WEA PROVIDER NETWORK | WEA INSURANCE CORPORATION | $255.55 | ↑ +44% |
| FIRST HEALTH | ALL COMMERCIAL FIRST HEALTH NETWORK | $255.55 | ↑ +44% |
| CATERPILLAR, INC. | UHC CATERPILLAR EMPLOYER GROUP | $269.00 | ↑ +52% |
| LIVE360 | LIVE360 HSHS HEALTHY PLAN | $269.00 | ↑ +52% |
| AETNA | ALL COMMERCIAL AETNA | $269.00 | ↑ +52% |
| HEALTHSMART | ALL COMMERCIAL HEALTHSMART | $269.00 | ↑ +52% |
Visitor-reported prices
Comments
Aco annual medicare visit (awv), initial g0438aco at other Wisconsin hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UnityPoint Health - Meriter Hospital | Madison | $338.40 | $38.41 – $291.17 |
| Aurora Sinai Medical Center of Aurora Health Care Metro | Milwaukee | $50.00 | not published |
| Ascension Calumet Hospital, Inc. | Chilton | $273.60 | $182.28 – $374.21 |
| SSM Health St. Clare Hospital - Baraboo | Baraboo | not published | $125.24 – $166.99 |
| SSM Health St. Mary's Hospital - Janesville | Janesville | not published | $125.24 – $166.99 |
| SSM Health Monroe Hospital | Monroe | not published | $166.99 – $166.99 |
| SSM Health St. Agnes Hospital - Fond du Lac | Fond Du Lac | not published | $125.24 – $322.29 |