Consultation pathology during surgery at HSHS St. Nicholas Hospital
3100 SUPERIOR AVE, SHEBOYGAN, WI · Hshs · · NPI 1730184342
$353.10
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.
$535.00
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.
$36.94 with ANTHEM vs $535.00 with CATERPILLAR, INC. — 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 |
|---|---|---|---|
| ANTHEM | ANTEHM MEDICAID | $36.94 | ↓ -90% |
| COMMUNITY CARE FAMILY CARE | COMMUNITY CARE FAMILY CARE MEDICAID MANAGED | $36.94 | ↓ -90% |
| CONTINUUS MEDICAID MANAGED | CONTINUUS MEDICAID MANAGED | $36.94 | ↓ -90% |
| MERIDIAN HEALTH PLAN | MERIDIAN HMO MCD | $36.94 | ↓ -90% |
| MANAGED HEALTH SERVICES | MANAGED HEALTH SERVICES MEDICAID | $36.94 | ↓ -90% |
| TRIOLOGY | TRILOGY MEDICAID | $39.15 | ↓ -89% |
| MOLINA HEALTHCARE | MOLINA MEDICAID | $39.16 | ↓ -89% |
| UNITED HEALTHCARE | UHC ONEIDA NATION | $40.75 | ↓ -88% |
| UNITED HEALTHCARE | ALL COMMERCIAL UNITED HEALTHCARE | $40.75 | ↓ -88% |
| UNITED HEALTHCARE | UNITED HEALTHCARE | $40.75 | ↓ -88% |
| ANTHEM | ANTHEM MEDICARE ADVANTAGE HMO | $57.69 | ↓ -84% |
| UNITED HEALTHCARE | UNITED HEALTH CARE MEDICARE | $57.69 | ↓ -84% |
| AETNA | AETNA MEDICARE | $57.69 | ↓ -84% |
| MEDICARE MANAGED | MANAGED MEDICARE NO SEQUESTRATION | $57.69 | ↓ -84% |
| MOLINA HEALTHCARE | MOLINA MEDICARE | $57.69 | ↓ -84% |
| HUMANA | HUMANA MEDICARE ADVANTAGE | $57.69 | ↓ -84% |
| MEDICA | MEDICA MEDICARE ADVANTAGE | $57.69 | ↓ -84% |
| SECURITY HEALTH PLAN | MEDICARE ADVANTAGE SECURITY HEALTH PLAN OF WI | $58.27 | ↓ -83% |
| HUMANA | HUMANA NATIIONAL POS HMO | $89.57 | ↓ -75% |
| HUMANA | HUMANA CHOICE CARE HMO | $89.57 | ↓ -75% |
| HUMANA | ALL COMMERCIAL HUMANA HPN CHOICECARE | $89.57 | ↓ -75% |
| ANTHEM | ANTHEM PPO | $119.10 | ↓ -66% |
| ANTHEM | ANTHEM POS/HMO | $119.10 | ↓ -66% |
| NAPHCARE | ALL COMMERICAL NAPHCARE | $129.81 | ↓ -63% |
| HSHS EMPLOYEES | HSHS EMPLOYEES | $260.01 | ↓ -26% |
| MOLINA HEALTHCARE OF WI | ALL COMMERICAL MOLINA MARKETPLACE | $267.50 | ↓ -24% |
| ARISE HEALTH PLAN | ALL COMMERCIAL ARISE HEALTH PLAN | $321.00 | ↓ -9% |
| P360 SMALL GROUP | PREVEA 360 SMALL GROUP COMMERCIAL PLAN | $321.00 | ↓ -9% |
| PREVEA HEALTH NETWORK | PREVEA EMPLOYEES | $321.00 | ↓ -9% |
| PREVEA HEALTH NETWORK | PREVEA360 | $321.00 | ↓ -9% |
| PREVEA HEALTH NETWORK | PREVEA360 - NETWORK | $321.00 | ↓ -9% |
| WEA PROVIDER NETWORK | WEA INSURANCE CORPORATION PPP | $331.70 | ↓ -6% |
| SECURITY HEALTH PLAN | ALL COMMERCIAL SECURITY HEALTH PLAN BROAD NETWORK | $341.49 | ↓ -3% |
| INTERPLAN | ALL COMMERCIAL INTERPLAN HEALTH GROUP | $374.50 | ↑ +6% |
| CIGNA | ALL COMMERCIAL CIGNA | $374.50 | ↑ +6% |
| WEA PROVIDER NETWORK | WEA TRUST PPP/TRUST PREFERRED | $385.20 | ↑ +9% |
| WEA PROVIDER NETWORK | WEA INSURANCE CORPORATION | $385.20 | ↑ +9% |
| WEA PROVIDER NETWORK | WEA INSURANCE CORPORATION TRUST SELECT | $385.20 | ↑ +9% |
| NETWORK HEALTH PLAN | ALL COMMERICAL NETWORK HEALTH PLAN | $401.25 | ↑ +14% |
| HEALTH EOS | ALL COMMERCIAL HEALTH EOS | $401.25 | ↑ +14% |
| HEALTHSMART | ALL COMMERCIAL HEALTHSMART | $401.25 | ↑ +14% |
| TRIOLOGY | ALL COMMERCIAL TRIOLOGY | $422.65 | ↑ +20% |
| WISCONSIN PHYSICIAN SERVICE | WISCONSIN PHYSICIAN SERVICE | $428.00 | ↑ +21% |
| MULTIPLAN/PHCS | ALL COMMERCIAL MULTIPLAN | $449.40 | ↑ +27% |
| HEALTH CARE ALLIANCE | THE ALLIANCE | $449.40 | ↑ +27% |
| HUMANA | HUMANA CHOICE CARE PPO | $454.75 | ↑ +29% |
| CHOICECARE | ALL COMMERCIAL CHOICE CARE | $454.75 | ↑ +29% |
| NORTH CENTRAL HEALTHCARE ALLIANCE | NEHA | $492.20 | ↑ +39% |
| FIRST HEALTH | ALL COMMERCIAL FIRST HEALTH NETWORK | $508.25 | ↑ +44% |
| COFINITY | COFINITY | $535.00 | ↑ +52% |
| AETNA | ALL COMMERCIAL AETNA | $535.00 | ↑ +52% |
| LIVE360 | LIVE360 HSHS HEALTHY PLAN | $535.00 | ↑ +52% |
| CATERPILLAR, INC. | UHC CATERPILLAR EMPLOYER GROUP | $535.00 | ↑ +52% |
Visitor-reported prices
Comments
Consultation pathology during surgery at other Wisconsin hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| Aurora Medical Center Sheboygan County | Sheboygan | not published | $43.60 – $65.76 |
| Ascension Columbia St. Mary's Hospital - Milwaukee Campus (Columbia St. Mary's Hospital Milwaukee, Inc.) | Milwaukee | $50.35 | $24.95 – $164.52 |
| Ascension Columbia St. Mary's Hospital - Ozaukee Campus (Columbia St. Mary's Hospital Milwaukee, Inc.) | Mequon | $50.35 | $24.95 – $164.52 |
| SSM Health Monroe Hospital | Monroe | $177.10 | $40.50 – $57.30 |
| Midwest Orthopedic Specialty Hospital | Franklin | $52.47 | $24.95 – $169.43 |
| Ascension NE Wisconsin - Mercy Campus (Ascension NE Wisconsin, Inc.) | Oshkosh | $100.89 | $23.29 – $134.99 |
| Ascension St. Francis Hospital, Inc. | Milwaukee | $52.47 | $24.95 – $169.43 |
| Ascension SE Wisconsin Hospital - St. Joseph Campus | Milwaukee | $52.47 | $24.95 – $169.43 |