CMS Price Transparency Data

CT scan, abdomen and pelvis (no contrast)

Facility: St Nicholas Hospital

Billing Code: 74176 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 74176
  • Insurance Median: $1,273
  • Cash Discount Price: $2,545
  • vs. Medicare Baseline: 5.22x Medicare
The contracted insurance negotiated median rate for a CT scan, abdomen and pelvis (no contrast) at St Nicholas Hospital is $1,273. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,545. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 5.22x the Medicare baseline. Located in 3100 Superior Ave, Sheboygan, WI.
Cash / Self-Pay
$2,545

Average discount available for prompt cash payment at this facility.

Insurance Median
$1,273

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate
$243.77

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $243.77 (100%)
Cash / Self-Pay: $2,545 (1044%)
Insurance Median: $1,273 (522%)
Cash: $2,545 (1044% of Medicare)
Ins. Median: $1,273 (522% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $243.77 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 522% of the Medicare baseline (a markup of 422%). 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
Molina Healthcare $93 - $234 38%
Security Health Plan $94 - $2,461 39%
Blue Cross Blue Shield $130 - $1,358 53%
Community Care Family Care $130 53%
Managed Health Services $130 53%
Medicaid / KanCare $130 53%
Meridian Health Plan $130 53%
Triology $138 - $3,046 57%
Aetna $234 - $3,856 96%
Humana $234 - $3,278 96%
Medica $234 96%
Medicare (plans) $234 96%
UnitedHealthcare $234 - $1,184 96%
Naphcare $526 216%
P360 Small Group $1,123 461%
Prevea Health Network $1,123 461%
Molina Healthcare Of Wi $1,928 791%
Hshs Employees $2,090 857%
Arise Health Plan $2,314 949%
Wea Provider Network $2,391 - $2,776 981%
Cigna $2,699 1107%
Interplan $2,699 1107%
Network Health Plan $2,699 1107%
Health Care Alliance $2,815 1155%
Health Eos $2,892 1186%
Healthsmart $2,892 1186%
Wisconsin Physician Service $3,085 1266%
Multiplan/Phcs $3,239 1329%
Choicecare $3,278 1345%
North Central Healthcare Alliance $3,548 1455%
First Health $3,663 1503%
Caterpillar, Inc. $3,856 1582%
Cofinity $3,856 1582%
Live360 $3,856 1582%

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