CMS Price Transparency Data

Diagnostic mammogram (both breasts)

Facility: St Nicholas Hospital

Billing Code: 77066 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 77066
  • Insurance Median: $336
  • Cash Discount Price: $370
  • vs. Medicare Baseline: 2.14x Medicare
The contracted insurance negotiated median rate for a Diagnostic mammogram (both breasts) at St Nicholas Hospital is $336. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $370. Compared to the federal Medicare reimbursement reference rate of $156.98, this hospital’s rate is 2.14x the Medicare baseline. Located in 3100 Superior Ave, Sheboygan, WI.
Cash / Self-Pay
$370

Average discount available for prompt cash payment at this facility.

Insurance Median
$336

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate
$156.98

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $156.98 (100%)
Cash / Self-Pay: $370 (236%)
Insurance Median: $336 (214%)
Cash: $370 (236% of Medicare)
Ins. Median: $336 (214% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $156.98 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 214% of the Medicare baseline (a markup of 114%). 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 $20 - $560 13%
Community Care Family Care $20 13%
Managed Health Services $20 13%
Medicaid / KanCare $20 13%
Meridian Health Plan $20 13%
Molina Healthcare $22 - $560 14%
Triology $22 - $442 14%
Aetna $93 - $560 59%
Humana $93 - $560 59%
Medica $93 - $560 59%
Medicare (plans) $93 - $560 59%
UnitedHealthcare $93 - $560 59%
Security Health Plan $94 - $566 60%
Naphcare $232 148%
Molina Healthcare Of Wi $280 178%
Hshs Employees $304 194%
Arise Health Plan $336 214%
P360 Small Group $336 214%
Prevea Health Network $336 214%
Wea Provider Network $347 - $403 221%
Cigna $392 250%
Interplan $392 250%
Network Health Plan $392 250%
Health Care Alliance $409 261%
Health Eos $420 268%
Healthsmart $420 268%
Wisconsin Physician Service $448 285%
Multiplan/Phcs $470 299%
Choicecare $476 303%
North Central Healthcare Alliance $515 328%
First Health $532 339%
Caterpillar, Inc. $560 357%
Cofinity $560 357%
Live360 $560 357%

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