Established Patient Office Visit (level 3) at HSHS St. Nicholas Hospital
3100 SUPERIOR AVE, SHEBOYGAN, WI · Hshs · · NPI 1730184342
$243.54
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.
$369.00
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.
$95.40 with UNITED HEALTHCARE vs $369.00 with COFINITY — 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 |
|---|---|---|---|
| UNITED HEALTHCARE | UNITED HEALTHCARE | $95.40 | ↓ -61% |
| UNITED HEALTHCARE | ALL COMMERCIAL UNITED HEALTHCARE | $95.40 | ↓ -61% |
| UNITED HEALTHCARE | UHC ONEIDA NATION | $95.40 | ↓ -61% |
| HUMANA | ALL COMMERCIAL HUMANA HPN CHOICECARE | $113.00 | ↓ -54% |
| HUMANA | HUMANA CHOICE CARE HMO | $113.00 | ↓ -54% |
| HUMANA | HUMANA NATIIONAL POS HMO | $113.00 | ↓ -54% |
| ANTHEM | ANTHEM POS/HMO | $154.00 | ↓ -37% |
| ANTHEM | ANTHEM PPO | $154.00 | ↓ -37% |
| HSHS EMPLOYEES | HSHS EMPLOYEES | $179.33 | ↓ -26% |
| MOLINA HEALTHCARE OF WI | ALL COMMERICAL MOLINA MARKETPLACE | $184.50 | ↓ -24% |
| ARISE HEALTH PLAN | ALL COMMERCIAL ARISE HEALTH PLAN | $221.40 | ↓ -9% |
| P360 SMALL GROUP | PREVEA 360 SMALL GROUP COMMERCIAL PLAN | $221.40 | ↓ -9% |
| PREVEA HEALTH NETWORK | PREVEA EMPLOYEES | $221.40 | ↓ -9% |
| PREVEA HEALTH NETWORK | PREVEA360 | $221.40 | ↓ -9% |
| PREVEA HEALTH NETWORK | PREVEA360 - NETWORK | $221.40 | ↓ -9% |
| WEA PROVIDER NETWORK | WEA INSURANCE CORPORATION PPP | $228.78 | ↓ -6% |
| SECURITY HEALTH PLAN | ALL COMMERCIAL SECURITY HEALTH PLAN BROAD NETWORK | $235.53 | ↓ -3% |
| INTERPLAN | ALL COMMERCIAL INTERPLAN HEALTH GROUP | $258.30 | ↑ +6% |
| CIGNA | ALL COMMERCIAL CIGNA | $258.30 | ↑ +6% |
| WEA PROVIDER NETWORK | WEA TRUST PPP/TRUST PREFERRED | $265.68 | ↑ +9% |
| WEA PROVIDER NETWORK | WEA INSURANCE CORPORATION TRUST SELECT | $265.68 | ↑ +9% |
| WEA PROVIDER NETWORK | WEA INSURANCE CORPORATION | $265.68 | ↑ +9% |
| NETWORK HEALTH PLAN | ALL COMMERICAL NETWORK HEALTH PLAN | $276.75 | ↑ +14% |
| HEALTH EOS | ALL COMMERCIAL HEALTH EOS | $276.75 | ↑ +14% |
| HEALTHSMART | ALL COMMERCIAL HEALTHSMART | $276.75 | ↑ +14% |
| TRIOLOGY | ALL COMMERCIAL TRIOLOGY | $291.51 | ↑ +20% |
| WISCONSIN PHYSICIAN SERVICE | WISCONSIN PHYSICIAN SERVICE | $295.20 | ↑ +21% |
| MULTIPLAN/PHCS | ALL COMMERCIAL MULTIPLAN | $309.96 | ↑ +27% |
| HEALTH CARE ALLIANCE | THE ALLIANCE | $309.96 | ↑ +27% |
| HUMANA | HUMANA CHOICE CARE PPO | $313.65 | ↑ +29% |
| CHOICECARE | ALL COMMERCIAL CHOICE CARE | $313.65 | ↑ +29% |
| NORTH CENTRAL HEALTHCARE ALLIANCE | NEHA | $339.48 | ↑ +39% |
| FIRST HEALTH | ALL COMMERCIAL FIRST HEALTH NETWORK | $350.55 | ↑ +44% |
| CATERPILLAR, INC. | UHC CATERPILLAR EMPLOYER GROUP | $369.00 | ↑ +52% |
| AETNA | ALL COMMERCIAL AETNA | $369.00 | ↑ +52% |
| LIVE360 | LIVE360 HSHS HEALTHY PLAN | $369.00 | ↑ +52% |
| COFINITY | COFINITY | $369.00 | ↑ +52% |
Visitor-reported prices
Comments
Established Patient Office Visit (level 3) at other Wisconsin hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| Aurora Medical Center Sheboygan County | Sheboygan | $172.50 | not published |
| Ascension Columbia St. Mary's Hospital - Milwaukee Campus (Columbia St. Mary's Hospital Milwaukee, Inc.) | Milwaukee | $427.18 | $106.79 – $188.14 |
| Ascension Columbia St. Mary's Hospital - Ozaukee Campus (Columbia St. Mary's Hospital Milwaukee, Inc.) | Mequon | $427.18 | $86.74 – $178.43 |
| UnityPoint Health - Meriter Hospital | Madison | $513.17 | $21.16 – $159.22 |
| SSM Health St. Clare Hospital - Baraboo | Baraboo | $105.05 | not published |
| SSM Health St. Mary's Hospital - Janesville | Janesville | $113.30 | not published |
| SSM Health St. Mary's Hospital - Madison | Madison | $92.40 | not published |
| SSM Health Ripon Community Hospital | Ripon | $187.00 | not published |