Established Patient Office Visit (level 4) at HSHS St. Clare Memorial Hospital
855 S MAIN STREET, OCONTO FALLS, WI · Hshs · · NPI 1851477913
$268.62
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.
$407.00
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.
$37.44 with MOLINA HEALTHCARE vs $156.00 with AETNA — 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 |
|---|---|---|---|
| MOLINA HEALTHCARE | MOLINA MEDICARE | $37.44 | ↓ -86% |
| UNITED HEALTHCARE | UNITED HEALTH CARE MEDICARE | $37.44 | ↓ -86% |
| AETNA | AETNA MEDICARE | $37.44 | ↓ -86% |
| ANTHEM | ANTHEM MEDICARE ADVANTAGE HMO | $37.44 | ↓ -86% |
| HUMANA | HUMANA MEDICARE ADVANTAGE | $37.44 | ↓ -86% |
| SECURITY HEALTH PLAN | MEDICARE ADVANTAGE SECURITY HEALTH PLAN OF WI | $37.81 | ↓ -86% |
| HSHS EMPLOYEES | HSHS EMPLOYEES | $75.82 | ↓ -72% |
| MOLINA HEALTHCARE OF WI | ALL COMMERICAL MOLINA MARKETPLACE | $78.00 | ↓ -71% |
| NAPHCARE | ALL COMMERICAL NAPHCARE | $84.24 | ↓ -69% |
| PREVEA HEALTH NETWORK | PREVEA EMPLOYEES | $93.60 | ↓ -65% |
| PREVEA HEALTH NETWORK | PREVEA360 - NETWORK | $93.60 | ↓ -65% |
| PREVEA HEALTH NETWORK | PREVEA360 | $93.60 | ↓ -65% |
| P360 SMALL GROUP | PREVEA 360 SMALL GROUP COMMERCIAL PLAN | $93.60 | ↓ -65% |
| UNITED HEALTHCARE | UNITED HEALTHCARE | $95.40 | ↓ -64% |
| UNITED HEALTHCARE | ALL COMMERCIAL UNITED HEALTHCARE | $95.40 | ↓ -64% |
| UNITED HEALTHCARE | UHC ONEIDA NATION | $95.40 | ↓ -64% |
| CIGNA | ALL COMMERCIAL CIGNA | $97.50 | ↓ -64% |
| SECURITY HEALTH PLAN | ALL COMMERCIAL SECURITY HEALTH PLAN BROAD NETWORK | $99.57 | ↓ -63% |
| TRIOLOGY | ALL COMMERCIAL TRIOLOGY | $123.24 | ↓ -54% |
| ARISE HEALTH PLAN | ALL COMMERCIAL ARISE HEALTH PLAN | $124.80 | ↓ -54% |
| WISCONSIN PHYSICIAN SERVICE | WISCONSIN PHYSICIAN SERVICE | $124.80 | ↓ -54% |
| WEA PROVIDER NETWORK | WEA INSURANCE CORPORATION PPP | $127.92 | ↓ -52% |
| WEA PROVIDER NETWORK | WEA TRUST PPP/TRUST PREFERRED | $127.92 | ↓ -52% |
| HEALTH CARE ALLIANCE | THE ALLIANCE | $131.04 | ↓ -51% |
| HUMANA | ALL COMMERCIAL HUMANA HPN CHOICECARE | $132.60 | ↓ -51% |
| CHOICECARE | ALL COMMERCIAL CHOICE CARE | $132.60 | ↓ -51% |
| HUMANA | HUMANA NATIIONAL POS HMO | $132.60 | ↓ -51% |
| HUMANA | HUMANA CHOICE CARE PPO | $132.60 | ↓ -51% |
| HEALTH EOS | ALL COMMERCIAL HEALTH EOS | $138.84 | ↓ -48% |
| MULTIPLAN/PHCS | ALL COMMERCIAL MULTIPLAN | $138.84 | ↓ -48% |
| INTERPLAN | ALL COMMERCIAL INTERPLAN HEALTH GROUP | $140.40 | ↓ -48% |
| NETWORK HEALTH PLAN | ALL COMMERICAL NETWORK HEALTH PLAN | $140.40 | ↓ -48% |
| COFINITY | COFINITY | $140.40 | ↓ -48% |
| NORTH CENTRAL HEALTHCARE ALLIANCE | NEHA | $143.52 | ↓ -47% |
| WEA PROVIDER NETWORK | WEA INSURANCE CORPORATION | $148.20 | ↓ -45% |
| FIRST HEALTH | ALL COMMERCIAL FIRST HEALTH NETWORK | $148.20 | ↓ -45% |
| ANTHEM | ANTHEM PPO | $154.00 | ↓ -43% |
| ANTHEM | ANTHEM POS/HMO | $154.00 | ↓ -43% |
| LIVE360 | LIVE360 HSHS HEALTHY PLAN | $156.00 | ↓ -42% |
| CATERPILLAR, INC. | UHC CATERPILLAR EMPLOYER GROUP | $156.00 | ↓ -42% |
| HEALTHSMART | ALL COMMERCIAL HEALTHSMART | $156.00 | ↓ -42% |
| AETNA | ALL COMMERCIAL AETNA | $156.00 | ↓ -42% |
Visitor-reported prices
Comments
Established Patient Office Visit (level 4) at other Wisconsin hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| Ascension Columbia St. Mary's Hospital - Milwaukee Campus (Columbia St. Mary's Hospital Milwaukee, Inc.) | Milwaukee | $477.00 | $158.01 – $277.60 |
| Ascension Columbia St. Mary's Hospital - Ozaukee Campus (Columbia St. Mary's Hospital Milwaukee, Inc.) | Mequon | $477.00 | $122.48 – $259.52 |
| UnityPoint Health - Meriter Hospital | Madison | $693.74 | $30.36 – $234.23 |
| SSM Health St. Clare Hospital - Baraboo | Baraboo | $157.30 | not published |
| SSM Health St. Mary's Hospital - Janesville | Janesville | $124.30 | not published |
| SSM Health St. Mary's Hospital - Madison | Madison | $131.45 | not published |
| SSM Health Ripon Community Hospital | Ripon | $210.65 | not published |
| SSM Health St. Agnes Hospital - Fond du Lac | Fond Du Lac | $210.65 | not published |