CMS Price Transparency Data

Digestive disorders treatment (inpatient stay)

Facility: St Nicholas Hospital

Billing Code: 392 (MS-DRG)

The BaseRate · fair price high confidence

A fair price for this

$10,853

about 1.9× the $5,676 Medicare rate · typically $6,550–$14,755

modeled estimate · not a bill or quote

What this hospital charges insurers

$11,304

About the fair price

about $451 over the fair price · 2.0× Medicare

Medicare pays $5,676 Fair price $10,853 This hospital $11,304 Cash price $15,911 Hospital's list price $24,107

How we calculate the fair BaseRate →

How this hospital compares to other WI hospitals

Highest price of the 9 WI hospitals we have prices for — worth calling around.

Cheapest $5,090 Priciest $11,304

Black dot = this hospital, among the 9 WI hospitals with a price for this procedure. Full list below.

A fair price for a Digestive disorders treatment (inpatient stay) is about $10,853 (about 1.9× the $5,676 Medicare rate). St Nicholas Hospital charges insurers about $11,304, or about $15,911 in cash — about the fair price. Located in Sheboygan, WI.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

5 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Cigna✓ Humana Kaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$6,485 - $13,350	114%
Blue Cross Blue Shieldmajor	$6,485 - $17,248	114%
Aetnamajor	$6,485 - $24,107	114%
Cignamajor	$16,875	297%
Humanamajor	$6,485 - $20,491	114%
Health Net	$11,304	199%
Medica	$6,485	114%
Molina	$6,485 - $12,054	114%
Security Health Plan	$6,550 - $15,388	115%
+ 13 smaller / regional plans	$9,576 - $24,107

Government programs also on file: Medicare.

Excludes 6 rental-network / third-party entries (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price (about 15,911), before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the MS-DRG code on your bill matches exactly: 392.

Insurance Before you use insurance

Call your insurance company to confirm St Nicholas Hospital is in-network.
Ask your insurer whether prior approval is required for MS-DRG code 392.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at St Nicholas Hospital

Compare: Digestive disorders treatment (inpatient stay) at other WI hospitals

Thedacare Medical Center - Shawano · Shawano $5,090
Orthopaedic Hospital of Wisconsin · Glendale $5,344
Sauk Prairie Hospital · Prairie Du Sac $5,510
Oakleaf Surgical Hospital · Altoona $5,521
The Monroe Clinic · Monroe $5,545
Mile Bluff Medical Center · Mauston $5,607
Beloit Health System · Beloit $6,477
Gundersen Boscobel Area Hospital and Clinics · Boscobel $6,834

Insurance negotiated median for the same procedure, sorted lowest first.