CMS Price Transparency Data

Blood test, vitamin B12

Facility: St Nicholas Hospital

Billing Code: 82607 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 82607
  • Insurance Median: $53
  • Cash Discount Price: $90
  • vs. Medicare Baseline: 3.51x Medicare
The contracted insurance negotiated median rate for a Blood test, vitamin B12 at St Nicholas Hospital is $53. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $90. Compared to the federal Medicare reimbursement reference rate of $15.08, this hospital’s rate is 3.51x the Medicare baseline. Located in 3100 Superior Ave, Sheboygan, WI.
Cash / Self-Pay
$90

Average discount available for prompt cash payment at this facility.

Insurance Median
$53

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate
$15.08

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $15.08 (100%)
Cash / Self-Pay: $90 (597%)
Insurance Median: $53 (351%)
Cash: $90 (597% of Medicare)
Ins. Median: $53 (351% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $15.08 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 351% of the Medicare baseline (a markup of 251%). 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 $15 - $136 99%
Blue Cross Blue Shield $15 - $53 99%
Humana $15 - $116 99%
Medica $15 99%
Medicare (plans) $15 99%
Molina Healthcare $15 - $17 99%
Security Health Plan $15 - $87 99%
UnitedHealthcare $15 - $18 99%
Community Care Family Care $16 106%
Managed Health Services $16 106%
Medicaid / KanCare $16 106%
Meridian Health Plan $16 106%
Triology $17 - $107 113%
P360 Small Group $18 119%
Prevea Health Network $18 119%
Naphcare $34 225%
Molina Healthcare Of Wi $68 451%
Hshs Employees $74 491%
Arise Health Plan $82 544%
Wea Provider Network $84 - $98 557%
Cigna $95 630%
Interplan $95 630%
Network Health Plan $95 630%
Health Care Alliance $99 656%
Health Eos $102 676%
Healthsmart $102 676%
Wisconsin Physician Service $109 723%
Multiplan/Phcs $114 756%
Choicecare $116 769%
North Central Healthcare Alliance $125 829%
First Health $129 855%
Caterpillar, Inc. $136 902%
Cofinity $136 902%
Live360 $136 902%

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