CMS Price Transparency Data

CT scan, head (with and without contrast)

Facility: St Nicholas Hospital

Billing Code: 70470 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 70470
  • Insurance Median: $1,358
  • Cash Discount Price: $1,819
  • vs. Medicare Baseline: 7.58x Medicare
The contracted insurance negotiated median rate for a CT scan, head (with and without contrast) at St Nicholas Hospital is $1,358. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,819. Compared to the federal Medicare reimbursement reference rate of $179.2, this hospital’s rate is 7.58x the Medicare baseline. Located in 3100 Superior Ave, Sheboygan, WI.
Cash / Self-Pay
$1,819

Average discount available for prompt cash payment at this facility.

Insurance Median
$1,358

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate
$179.2

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $179.2 (100%)
Cash / Self-Pay: $1,819 (1015%)
Insurance Median: $1,358 (758%)
Cash: $1,819 (1015% of Medicare)
Ins. Median: $1,358 (758% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $179.2 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 758% of the Medicare baseline (a markup of 658%). 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
Blue Cross Blue Shield $130 - $1,358 73%
Community Care Family Care $130 73%
Managed Health Services $130 73%
Medicaid / KanCare $130 73%
Meridian Health Plan $130 73%
Molina Healthcare $138 - $172 77%
Triology $138 - $2,177 77%
Aetna $172 - $2,756 96%
Humana $172 - $2,343 96%
Medica $172 96%
Medicare (plans) $172 96%
UnitedHealthcare $172 - $1,184 96%
Security Health Plan $174 - $1,759 97%
Naphcare $387 216%
P360 Small Group $1,123 627%
Prevea Health Network $1,123 627%
Molina Healthcare Of Wi $1,378 769%
Hshs Employees $1,494 834%
Arise Health Plan $1,654 923%
Wea Provider Network $1,709 - $1,984 954%
Cigna $1,929 1076%
Interplan $1,929 1076%
Network Health Plan $1,929 1076%
Health Care Alliance $2,012 1123%
Health Eos $2,067 1153%
Healthsmart $2,067 1153%
Wisconsin Physician Service $2,205 1230%
Multiplan/Phcs $2,315 1292%
Choicecare $2,343 1307%
North Central Healthcare Alliance $2,536 1415%
First Health $2,618 1461%
Caterpillar, Inc. $2,756 1538%
Cofinity $2,756 1538%
Live360 $2,756 1538%

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