Bld prd mix at HSHS St. Nicholas Hospital
3100 SUPERIOR AVE, SHEBOYGAN, WI · Hshs · · NPI 1730184342
$198.00
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.
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What you pay up front if you don't use insurance.
$300.00
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.
$37.44 with MANAGED HEALTH SERVICES vs $374.88 with NAPHCARE — 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 |
|---|---|---|---|
| MANAGED HEALTH SERVICES | MANAGED HEALTH SERVICES MEDICAID | $37.44 | ↓ -81% |
| CONTINUUS MEDICAID MANAGED | CONTINUUS MEDICAID MANAGED | $37.44 | ↓ -81% |
| MERIDIAN HEALTH PLAN | MERIDIAN HMO MCD | $37.44 | ↓ -81% |
| COMMUNITY CARE FAMILY CARE | COMMUNITY CARE FAMILY CARE MEDICAID MANAGED | $37.44 | ↓ -81% |
| ANTHEM | ANTEHM MEDICAID | $37.44 | ↓ -81% |
| MOLINA HEALTHCARE | MOLINA MEDICAID | $39.69 | ↓ -80% |
| TRIOLOGY | TRILOGY MEDICAID | $39.69 | ↓ -80% |
| HUMANA | ALL COMMERCIAL HUMANA HPN CHOICECARE | $50.90 | ↓ -74% |
| HUMANA | HUMANA CHOICE CARE HMO | $50.90 | ↓ -74% |
| HUMANA | HUMANA NATIIONAL POS HMO | $50.90 | ↓ -74% |
| ANTHEM | ANTHEM POS/HMO | $108.39 | ↓ -45% |
| ANTHEM | ANTHEM PPO | $108.39 | ↓ -45% |
| HSHS EMPLOYEES | HSHS EMPLOYEES | $145.80 | ↓ -26% |
| MOLINA HEALTHCARE OF WI | ALL COMMERICAL MOLINA MARKETPLACE | $150.00 | ↓ -24% |
| MEDICARE MANAGED | MANAGED MEDICARE NO SEQUESTRATION | $166.61 | ↓ -16% |
| AETNA | AETNA MEDICARE | $166.61 | ↓ -16% |
| MEDICA | MEDICA MEDICARE ADVANTAGE | $166.61 | ↓ -16% |
| ANTHEM | ANTHEM MEDICARE ADVANTAGE HMO | $166.61 | ↓ -16% |
| HUMANA | HUMANA MEDICARE ADVANTAGE | $166.61 | ↓ -16% |
| MOLINA HEALTHCARE | MOLINA MEDICARE | $166.61 | ↓ -16% |
| UNITED HEALTHCARE | UNITED HEALTH CARE MEDICARE | $166.61 | ↓ -16% |
| SECURITY HEALTH PLAN | MEDICARE ADVANTAGE SECURITY HEALTH PLAN OF WI | $168.28 | ↓ -15% |
| ARISE HEALTH PLAN | ALL COMMERCIAL ARISE HEALTH PLAN | $180.00 | ↓ -9% |
| P360 SMALL GROUP | PREVEA 360 SMALL GROUP COMMERCIAL PLAN | $180.00 | ↓ -9% |
| PREVEA HEALTH NETWORK | PREVEA EMPLOYEES | $180.00 | ↓ -9% |
| PREVEA HEALTH NETWORK | PREVEA360 | $180.00 | ↓ -9% |
| PREVEA HEALTH NETWORK | PREVEA360 - NETWORK | $180.00 | ↓ -9% |
| WEA PROVIDER NETWORK | WEA INSURANCE CORPORATION PPP | $186.00 | ↓ -6% |
| UNITED HEALTHCARE | ALL COMMERCIAL UNITED HEALTHCARE | $188.70 | ↓ -5% |
| UNITED HEALTHCARE | UHC ONEIDA NATION | $188.70 | ↓ -5% |
| UNITED HEALTHCARE | UNITED HEALTHCARE | $188.70 | ↓ -5% |
| SECURITY HEALTH PLAN | ALL COMMERCIAL SECURITY HEALTH PLAN BROAD NETWORK | $191.49 | ↓ -3% |
| CIGNA | ALL COMMERCIAL CIGNA | $210.00 | ↑ +6% |
| INTERPLAN | ALL COMMERCIAL INTERPLAN HEALTH GROUP | $210.00 | ↑ +6% |
| WEA PROVIDER NETWORK | WEA TRUST PPP/TRUST PREFERRED | $216.00 | ↑ +9% |
| WEA PROVIDER NETWORK | WEA INSURANCE CORPORATION TRUST SELECT | $216.00 | ↑ +9% |
| WEA PROVIDER NETWORK | WEA INSURANCE CORPORATION | $216.00 | ↑ +9% |
| NETWORK HEALTH PLAN | ALL COMMERICAL NETWORK HEALTH PLAN | $225.00 | ↑ +14% |
| HEALTH EOS | ALL COMMERCIAL HEALTH EOS | $225.00 | ↑ +14% |
| HEALTHSMART | ALL COMMERCIAL HEALTHSMART | $225.00 | ↑ +14% |
| TRIOLOGY | ALL COMMERCIAL TRIOLOGY | $237.00 | ↑ +20% |
| WISCONSIN PHYSICIAN SERVICE | WISCONSIN PHYSICIAN SERVICE | $240.00 | ↑ +21% |
| MULTIPLAN/PHCS | ALL COMMERCIAL MULTIPLAN | $252.00 | ↑ +27% |
| HEALTH CARE ALLIANCE | THE ALLIANCE | $252.00 | ↑ +27% |
| HUMANA | HUMANA CHOICE CARE PPO | $255.00 | ↑ +29% |
| CHOICECARE | ALL COMMERCIAL CHOICE CARE | $255.00 | ↑ +29% |
| NORTH CENTRAL HEALTHCARE ALLIANCE | NEHA | $276.00 | ↑ +39% |
| FIRST HEALTH | ALL COMMERCIAL FIRST HEALTH NETWORK | $285.00 | ↑ +44% |
| AETNA | ALL COMMERCIAL AETNA | $300.00 | ↑ +52% |
| CATERPILLAR, INC. | UHC CATERPILLAR EMPLOYER GROUP | $300.00 | ↑ +52% |
| LIVE360 | LIVE360 HSHS HEALTHY PLAN | $300.00 | ↑ +52% |
| COFINITY | COFINITY | $300.00 | ↑ +52% |
| NAPHCARE | ALL COMMERICAL NAPHCARE | $374.88 | ↑ +89% |
Visitor-reported prices
Comments
Bld prd mix at other Wisconsin hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| Aurora Medical Center Sheboygan County | Sheboygan | not published | $27.14 – $89.82 |
| Ascension Columbia St. Mary's Hospital - Milwaukee Campus (Columbia St. Mary's Hospital Milwaukee, Inc.) | Milwaukee | $149.99 | $36.67 – $367.00 |
| Ascension Columbia St. Mary's Hospital - Ozaukee Campus (Columbia St. Mary's Hospital Milwaukee, Inc.) | Mequon | $149.99 | $36.67 – $367.00 |
| UnityPoint Health - Meriter Hospital | Madison | $64.28 | $18.48 – $165.52 |
| SSM Health St. Clare Hospital - Baraboo | Baraboo | $66.00 | $124.11 – $219.70 |
| SSM Health St. Mary's Hospital - Janesville | Janesville | $76.45 | $128.70 – $175.76 |
| SSM Health St. Mary's Hospital - Madison | Madison | $72.05 | $124.11 – $179.75 |
| Midwest Orthopedic Specialty Hospital | Franklin | $90.63 | $36.67 – $232.95 |