CMS Price Transparency Data

CT scan, neck (cervical spine)

Facility: St Nicholas Hospital

Billing Code: 72125 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 72125
  • Insurance Median: $1,273
  • Cash Discount Price: $1,358
  • vs. Medicare Baseline: 11.92x Medicare
The contracted insurance negotiated median rate for a CT scan, neck (cervical spine) at St Nicholas Hospital is $1,273. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,358. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 11.92x the Medicare baseline. Located in 3100 Superior Ave, Sheboygan, WI.
Cash / Self-Pay
$1,358

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
$106.81

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $106.81 (100%)
Cash / Self-Pay: $1,358 (1271%)
Insurance Median: $1,273 (1192%)
Cash: $1,358 (1271% of Medicare)
Ins. Median: $1,273 (1192% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $106.81 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 1192% of the Medicare baseline (a markup of 1092%). 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 $46 - $1,358 43%
Community Care Family Care $46 43%
Managed Health Services $46 43%
Medicaid / KanCare $46 43%
Meridian Health Plan $46 43%
Molina Healthcare $48 - $103 45%
Triology $48 - $1,625 45%
Aetna $103 - $2,057 96%
Humana $103 - $1,748 96%
Medica $103 96%
Medicare (plans) $103 96%
UnitedHealthcare $103 - $1,184 96%
Security Health Plan $104 - $1,313 97%
Naphcare $231 216%
Molina Healthcare Of Wi $1,028 962%
Hshs Employees $1,115 1044%
P360 Small Group $1,123 1051%
Prevea Health Network $1,123 1051%
Arise Health Plan $1,234 1155%
Wea Provider Network $1,275 - $1,481 1194%
Cigna $1,440 1348%
Interplan $1,440 1348%
Network Health Plan $1,440 1348%
Health Care Alliance $1,502 1406%
Health Eos $1,543 1445%
Healthsmart $1,543 1445%
Wisconsin Physician Service $1,646 1541%
Multiplan/Phcs $1,728 1618%
Choicecare $1,748 1637%
North Central Healthcare Alliance $1,892 1771%
First Health $1,954 1829%
Caterpillar, Inc. $2,057 1926%
Cofinity $2,057 1926%
Live360 $2,057 1926%

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