Biopsy of salivary gland 42400 at HSHS St. Nicholas Hospital
3100 SUPERIOR AVE, SHEBOYGAN, WI · Hshs · · NPI 1730184342
$1,087.02
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.
$1,647.00
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.
$102.05 with HUMANA vs $1,647.00 with COFINITY — 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 |
|---|---|---|---|
| HUMANA | ALL COMMERCIAL HUMANA HPN CHOICECARE | $102.05 | ↓ -91% |
| HUMANA | HUMANA NATIIONAL POS HMO | $102.05 | ↓ -91% |
| HUMANA | HUMANA CHOICE CARE HMO | $102.05 | ↓ -91% |
| PREVEA HEALTH NETWORK | PREVEA360 | $422.00 | ↓ -61% |
| P360 SMALL GROUP | PREVEA 360 SMALL GROUP COMMERCIAL PLAN | $456.60 | ↓ -58% |
| PREVEA HEALTH NETWORK | PREVEA360 - NETWORK | $456.60 | ↓ -58% |
| PREVEA HEALTH NETWORK | PREVEA EMPLOYEES | $456.60 | ↓ -58% |
| UNITED HEALTHCARE | UHC ONEIDA NATION | $495.60 | ↓ -54% |
| UNITED HEALTHCARE | ALL COMMERCIAL UNITED HEALTHCARE | $495.60 | ↓ -54% |
| UNITED HEALTHCARE | UNITED HEALTHCARE | $495.60 | ↓ -54% |
| CONTINUUS MEDICAID MANAGED | CONTINUUS MEDICAID MANAGED | $528.96 | ↓ -51% |
| COMMUNITY CARE FAMILY CARE | COMMUNITY CARE FAMILY CARE MEDICAID MANAGED | $528.96 | ↓ -51% |
| MERIDIAN HEALTH PLAN | MERIDIAN HMO MCD | $528.96 | ↓ -51% |
| MANAGED HEALTH SERVICES | MANAGED HEALTH SERVICES MEDICAID | $528.96 | ↓ -51% |
| ANTHEM | ANTEHM MEDICAID | $528.96 | ↓ -51% |
| TRIOLOGY | TRILOGY MEDICAID | $560.70 | ↓ -48% |
| MOLINA HEALTHCARE | MOLINA MEDICAID | $560.70 | ↓ -48% |
| UNITED HEALTHCARE | UNITED HEALTH CARE MEDICARE | $692.52 | ↓ -36% |
| MEDICARE MANAGED | MANAGED MEDICARE NO SEQUESTRATION | $692.52 | ↓ -36% |
| AETNA | AETNA MEDICARE | $692.52 | ↓ -36% |
| HUMANA | HUMANA MEDICARE ADVANTAGE | $692.52 | ↓ -36% |
| MOLINA HEALTHCARE | MOLINA MEDICARE | $692.52 | ↓ -36% |
| ANTHEM | ANTHEM MEDICARE ADVANTAGE HMO | $692.52 | ↓ -36% |
| MEDICA | MEDICA MEDICARE ADVANTAGE | $692.52 | ↓ -36% |
| SECURITY HEALTH PLAN | MEDICARE ADVANTAGE SECURITY HEALTH PLAN OF WI | $699.45 | ↓ -36% |
| HSHS EMPLOYEES | HSHS EMPLOYEES | $800.44 | ↓ -26% |
| MOLINA HEALTHCARE OF WI | ALL COMMERICAL MOLINA MARKETPLACE | $823.50 | ↓ -24% |
| ARISE HEALTH PLAN | ALL COMMERCIAL ARISE HEALTH PLAN | $988.20 | ↓ -9% |
| WEA PROVIDER NETWORK | WEA INSURANCE CORPORATION PPP | $1,021.14 | ↓ -6% |
| SECURITY HEALTH PLAN | ALL COMMERCIAL SECURITY HEALTH PLAN BROAD NETWORK | $1,051.28 | ↓ -3% |
| ANTHEM | ANTHEM PPO | $1,119.96 | ↑ +3% |
| ANTHEM | ANTHEM POS/HMO | $1,119.96 | ↑ +3% |
| INTERPLAN | ALL COMMERCIAL INTERPLAN HEALTH GROUP | $1,152.90 | ↑ +6% |
| CIGNA | ALL COMMERCIAL CIGNA | $1,152.90 | ↑ +6% |
| WEA PROVIDER NETWORK | WEA TRUST PPP/TRUST PREFERRED | $1,185.84 | ↑ +9% |
| WEA PROVIDER NETWORK | WEA INSURANCE CORPORATION TRUST SELECT | $1,185.84 | ↑ +9% |
| WEA PROVIDER NETWORK | WEA INSURANCE CORPORATION | $1,185.84 | ↑ +9% |
| HEALTHSMART | ALL COMMERCIAL HEALTHSMART | $1,235.25 | ↑ +14% |
| NETWORK HEALTH PLAN | ALL COMMERICAL NETWORK HEALTH PLAN | $1,235.25 | ↑ +14% |
| HEALTH EOS | ALL COMMERCIAL HEALTH EOS | $1,235.25 | ↑ +14% |
| TRIOLOGY | ALL COMMERCIAL TRIOLOGY | $1,301.13 | ↑ +20% |
| WISCONSIN PHYSICIAN SERVICE | WISCONSIN PHYSICIAN SERVICE | $1,317.60 | ↑ +21% |
| HEALTH CARE ALLIANCE | THE ALLIANCE | $1,383.48 | ↑ +27% |
| MULTIPLAN/PHCS | ALL COMMERCIAL MULTIPLAN | $1,383.48 | ↑ +27% |
| CHOICECARE | ALL COMMERCIAL CHOICE CARE | $1,399.95 | ↑ +29% |
| HUMANA | HUMANA CHOICE CARE PPO | $1,399.95 | ↑ +29% |
| NORTH CENTRAL HEALTHCARE ALLIANCE | NEHA | $1,515.24 | ↑ +39% |
| NAPHCARE | ALL COMMERICAL NAPHCARE | $1,558.17 | ↑ +43% |
| FIRST HEALTH | ALL COMMERCIAL FIRST HEALTH NETWORK | $1,564.65 | ↑ +44% |
| LIVE360 | LIVE360 HSHS HEALTHY PLAN | $1,647.00 | ↑ +52% |
| AETNA | ALL COMMERCIAL AETNA | $1,647.00 | ↑ +52% |
| CATERPILLAR, INC. | UHC CATERPILLAR EMPLOYER GROUP | $1,647.00 | ↑ +52% |
| COFINITY | COFINITY | $1,647.00 | ↑ +52% |
Visitor-reported prices
Comments
Biopsy of salivary gland 42400 at other Wisconsin hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| Aurora Medical Center Sheboygan County | Sheboygan | $725.00 | not published |
| Ascension Columbia St. Mary's Hospital - Milwaukee Campus (Columbia St. Mary's Hospital Milwaukee, Inc.) | Milwaukee | $1,748.47 | $85.24 – $1,506.85 |
| Ascension Columbia St. Mary's Hospital - Ozaukee Campus (Columbia St. Mary's Hospital Milwaukee, Inc.) | Mequon | $1,748.47 | $85.24 – $1,506.85 |
| UnityPoint Health - Meriter Hospital | Madison | $2,295.35 | $48.89 – $895.18 |
| SSM Health St. Clare Hospital - Baraboo | Baraboo | $1,528.45 | $515.87 – $4,401.00 |
| SSM Health St. Mary's Hospital - Janesville | Janesville | $1,022.45 | $534.95 – $4,074.00 |
| SSM Health St. Mary's Hospital - Madison | Madison | $957.55 | $515.87 – $4,198.00 |
| SSM Health Monroe Hospital | Monroe | $988.35 | $687.83 – $4,217.00 |