CMS Price Transparency Data

Blood test, liver function panel

Facility: St Nicholas Hospital

Billing Code: 80076 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 80076
  • Insurance Median: $29
  • Cash Discount Price: $69
  • vs. Medicare Baseline: 3.55x Medicare
The contracted insurance negotiated median rate for a Blood test, liver function panel at St Nicholas Hospital is $29. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $69. Compared to the federal Medicare reimbursement reference rate of $8.17, this hospital’s rate is 3.55x the Medicare baseline. Located in 3100 Superior Ave, Sheboygan, WI.
Cash / Self-Pay
$69

Average discount available for prompt cash payment at this facility.

Insurance Median
$29

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate
$8.17

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $8.17 (100%)
Cash / Self-Pay: $69 (845%)
Insurance Median: $29 (355%)
Cash: $69 (845% of Medicare)
Ins. Median: $29 (355% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $8.17 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 355% of the Medicare baseline (a markup of 255%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group Contract Rate Range vs. Medicare Reference
Aetna $8 - $104 98%
Blue Cross Blue Shield $8 - $29 98%
Community Care Family Care $8 98%
Humana $8 - $88 98%
Managed Health Services $8 98%
Medica $8 98%
Medicaid / KanCare $8 98%
Medicare (plans) $8 98%
Meridian Health Plan $8 98%
Molina Healthcare $8 - $9 98%
Security Health Plan $8 - $66 98%
UnitedHealthcare $8 - $10 98%
Triology $9 - $82 110%
P360 Small Group $10 122%
Prevea Health Network $10 122%
Naphcare $18 220%
Molina Healthcare Of Wi $52 636%
Hshs Employees $56 685%
Arise Health Plan $62 759%
Wea Provider Network $64 - $75 783%
Cigna $73 894%
Interplan $73 894%
Network Health Plan $73 894%
Health Care Alliance $76 930%
Health Eos $78 955%
Healthsmart $78 955%
Wisconsin Physician Service $83 1016%
Multiplan/Phcs $87 1065%
Choicecare $88 1077%
North Central Healthcare Alliance $96 1175%
First Health $99 1212%
Caterpillar, Inc. $104 1273%
Cofinity $104 1273%
Live360 $104 1273%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 3100 Superior Ave, Sheboygan, WI 53081
  • CMS Rating: ★★★☆☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals