CMS Price Transparency Data

CT scan, head (with contrast)

Facility: St Nicholas Hospital

Billing Code: 70460 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 70460
  • Insurance Median: $1,341
  • Cash Discount Price: $1,770
  • vs. Medicare Baseline: 7.48x Medicare
The contracted insurance negotiated median rate for a CT scan, head (with contrast) at St Nicholas Hospital is $1,341. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,770. Compared to the federal Medicare reimbursement reference rate of $179.2, this hospital’s rate is 7.48x the Medicare baseline. Located in 3100 Superior Ave, Sheboygan, WI.
Cash / Self-Pay
$1,770

Average discount available for prompt cash payment at this facility.

Insurance Median
$1,341

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: $1,770 (988%)
Insurance Median: $1,341 (748%)
Cash: $1,770 (988% of Medicare)
Ins. Median: $1,341 (748% 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 748% of the Medicare baseline (a markup of 648%). 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 - $2,119 77%
Aetna $172 - $2,682 96%
Humana $172 - $2,280 96%
Medica $172 96%
Medicare (plans) $172 96%
UnitedHealthcare $172 - $1,184 96%
Security Health Plan $174 - $1,712 97%
Naphcare $387 216%
P360 Small Group $1,123 627%
Prevea Health Network $1,123 627%
Molina Healthcare Of Wi $1,341 748%
Hshs Employees $1,454 811%
Arise Health Plan $1,609 898%
Wea Provider Network $1,663 - $1,931 928%
Cigna $1,877 1047%
Interplan $1,877 1047%
Network Health Plan $1,877 1047%
Health Care Alliance $1,958 1093%
Health Eos $2,012 1123%
Healthsmart $2,012 1123%
Wisconsin Physician Service $2,146 1198%
Multiplan/Phcs $2,253 1257%
Choicecare $2,280 1272%
North Central Healthcare Alliance $2,467 1377%
First Health $2,548 1422%
Caterpillar, Inc. $2,682 1497%
Cofinity $2,682 1497%
Live360 $2,682 1497%

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