CMS Price Transparency Data

Blood test, potassium

Facility: St Nicholas Hospital

Billing Code: 84132 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 84132
  • Insurance Median: $17
  • Cash Discount Price: $29
  • vs. Medicare Baseline: 3.57x Medicare
The contracted insurance negotiated median rate for a Blood test, potassium at St Nicholas Hospital is $17. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $29. Compared to the federal Medicare reimbursement reference rate of $4.76, this hospital’s rate is 3.57x the Medicare baseline. Located in 3100 Superior Ave, Sheboygan, WI.
Cash / Self-Pay
$29

Average discount available for prompt cash payment at this facility.

Insurance Median
$17

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate
$4.76

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $4.76 (100%)
Cash / Self-Pay: $29 (609%)
Insurance Median: $17 (357%)
Cash: $29 (609% of Medicare)
Ins. Median: $17 (357% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $4.76 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 357% of the Medicare baseline (a markup of 257%). 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 $5 - $44 105%
Blue Cross Blue Shield $5 - $17 105%
Community Care Family Care $5 105%
Humana $5 - $37 105%
Managed Health Services $5 105%
Medica $5 105%
Medicaid / KanCare $5 105%
Medicare (plans) $5 105%
Meridian Health Plan $5 105%
Molina Healthcare $5 105%
Security Health Plan $5 - $28 105%
Triology $5 - $35 105%
UnitedHealthcare $5 - $6 105%
P360 Small Group $6 126%
Prevea Health Network $6 126%
Naphcare $11 231%
Molina Healthcare Of Wi $22 462%
Hshs Employees $24 504%
Arise Health Plan $26 546%
Wea Provider Network $27 - $32 567%
Cigna $31 651%
Interplan $31 651%
Network Health Plan $31 651%
Health Care Alliance $32 672%
Health Eos $33 693%
Healthsmart $33 693%
Wisconsin Physician Service $35 735%
Choicecare $37 777%
Multiplan/Phcs $37 777%
North Central Healthcare Alliance $40 840%
First Health $42 882%
Caterpillar, Inc. $44 924%
Cofinity $44 924%
Live360 $44 924%

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