Pr exam init preventive phys new visit during 1st 12 mo of mcare enrollment at HSHS St. Clare Memorial Hospital
855 S MAIN STREET, OCONTO FALLS, WI · Hshs · · NPI 1851477913
$149.16
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.
$226.00
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.
$54.24 with HUMANA vs $226.00 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 |
|---|---|---|---|
| HUMANA | HUMANA MEDICARE ADVANTAGE | $54.24 | ↓ -64% |
| UNITED HEALTHCARE | UNITED HEALTH CARE MEDICARE | $54.24 | ↓ -64% |
| MOLINA HEALTHCARE | MOLINA MEDICARE | $54.24 | ↓ -64% |
| AETNA | AETNA MEDICARE | $54.24 | ↓ -64% |
| ANTHEM | ANTHEM MEDICARE ADVANTAGE HMO | $54.24 | ↓ -64% |
| SECURITY HEALTH PLAN | MEDICARE ADVANTAGE SECURITY HEALTH PLAN OF WI | $54.78 | ↓ -63% |
| UNITED HEALTHCARE | ALL COMMERCIAL UNITED HEALTHCARE | $95.40 | ↓ -36% |
| UNITED HEALTHCARE | UHC ONEIDA NATION | $95.40 | ↓ -36% |
| UNITED HEALTHCARE | UNITED HEALTHCARE | $95.40 | ↓ -36% |
| HSHS EMPLOYEES | HSHS EMPLOYEES | $109.84 | ↓ -26% |
| MOLINA HEALTHCARE OF WI | ALL COMMERICAL MOLINA MARKETPLACE | $113.00 | ↓ -24% |
| NAPHCARE | ALL COMMERICAL NAPHCARE | $122.04 | ↓ -18% |
| PREVEA HEALTH NETWORK | PREVEA360 | $135.60 | ↓ -9% |
| PREVEA HEALTH NETWORK | PREVEA EMPLOYEES | $135.60 | ↓ -9% |
| PREVEA HEALTH NETWORK | PREVEA360 - NETWORK | $135.60 | ↓ -9% |
| P360 SMALL GROUP | PREVEA 360 SMALL GROUP COMMERCIAL PLAN | $135.60 | ↓ -9% |
| UNITY HEALTH PLAN | UNITY HOSPICE | $136.02 | ↓ -9% |
| CIGNA | ALL COMMERCIAL CIGNA | $141.25 | ↓ -5% |
| SECURITY HEALTH PLAN | ALL COMMERCIAL SECURITY HEALTH PLAN BROAD NETWORK | $144.26 | ↓ -3% |
| ANTHEM | ANTHEM PPO | $154.00 | ↑ +3% |
| ANTHEM | ANTHEM POS/HMO | $154.00 | ↑ +3% |
| TRIOLOGY | ALL COMMERCIAL TRIOLOGY | $178.54 | ↑ +20% |
| ARISE HEALTH PLAN | ALL COMMERCIAL ARISE HEALTH PLAN | $180.80 | ↑ +21% |
| WISCONSIN PHYSICIAN SERVICE | WISCONSIN PHYSICIAN SERVICE | $180.80 | ↑ +21% |
| WEA PROVIDER NETWORK | WEA TRUST PPP/TRUST PREFERRED | $185.32 | ↑ +24% |
| WEA PROVIDER NETWORK | WEA INSURANCE CORPORATION PPP | $185.32 | ↑ +24% |
| HEALTH CARE ALLIANCE | THE ALLIANCE | $189.84 | ↑ +27% |
| HUMANA | HUMANA CHOICE CARE PPO | $192.10 | ↑ +29% |
| CHOICECARE | ALL COMMERCIAL CHOICE CARE | $192.10 | ↑ +29% |
| HUMANA | HUMANA NATIIONAL POS HMO | $192.10 | ↑ +29% |
| HUMANA | ALL COMMERCIAL HUMANA HPN CHOICECARE | $192.10 | ↑ +29% |
| HEALTH EOS | ALL COMMERCIAL HEALTH EOS | $201.14 | ↑ +35% |
| MULTIPLAN/PHCS | ALL COMMERCIAL MULTIPLAN | $201.14 | ↑ +35% |
| COFINITY | COFINITY | $203.40 | ↑ +36% |
| INTERPLAN | ALL COMMERCIAL INTERPLAN HEALTH GROUP | $203.40 | ↑ +36% |
| NETWORK HEALTH PLAN | ALL COMMERICAL NETWORK HEALTH PLAN | $203.40 | ↑ +36% |
| NORTH CENTRAL HEALTHCARE ALLIANCE | NEHA | $207.92 | ↑ +39% |
| WEA PROVIDER NETWORK | WEA INSURANCE CORPORATION | $214.70 | ↑ +44% |
| FIRST HEALTH | ALL COMMERCIAL FIRST HEALTH NETWORK | $214.70 | ↑ +44% |
| AETNA | ALL COMMERCIAL AETNA | $226.00 | ↑ +52% |
| LIVE360 | LIVE360 HSHS HEALTHY PLAN | $226.00 | ↑ +52% |
| CATERPILLAR, INC. | UHC CATERPILLAR EMPLOYER GROUP | $226.00 | ↑ +52% |
| HEALTHSMART | ALL COMMERCIAL HEALTHSMART | $226.00 | ↑ +52% |
Visitor-reported prices
Comments
Pr exam init preventive phys new visit during 1st 12 mo of mcare enrollment at other Wisconsin hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UnityPoint Health - Meriter Hospital | Madison | $263.20 | $34.27 – $177.78 |
| SSM Health Monroe Hospital | Monroe | $127.60 | $129.32 – $129.32 |
| SSM Health Ripon Community Hospital | Ripon | $175.75 | not published |
| SSM Health St. Agnes Hospital - Fond du Lac | Fond Du Lac | $175.75 | $98.76 – $254.15 |
| SSM Health Waupun Memorial Hospital | Waupun | $175.75 | not published |
| Aurora Sinai Medical Center of Aurora Health Care Metro | Milwaukee | $67.50 | not published |
| Ascension Calumet Hospital, Inc. | Chilton | $91.77 | $143.08 – $143.08 |
| SSM Health St. Clare Hospital - Baraboo | Baraboo | not published | $96.99 – $129.32 |