CMS Price Transparency Data

Office visit, established patient (30-39 min)

Facility: St Nicholas Hospital

Billing Code: 99214 (CPT)

The BaseRate · fair price high confidence
A fair price for this
$112
about 0.8× the $136 Medicare rate · typically $87–$216
modeled estimate · not a bill or quote
What this hospital charges insurers
$113
About the fair price
about $1 over the fair price · 0.8× Medicare
Medicare pays $136 Fair price $112 This hospital $113 Cash price $269 Hospital's list price $407

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 $73 Priciest $113

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

A fair price for a Office visit, established patient (30-39 min) is about $112 (about 0.8× the $136 Medicare rate). St Nicholas Hospital charges insurers about $113, or about $269 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 $90 - $95 66%
Blue Cross Blue Shieldmajor $126 - $159 93%
Aetnamajor $407 300%
Cignamajor $285 210%
Humanamajor $113 - $346 83%
Health Net $244 180%
Molina $204 150%
Security Health Plan $260 192%
+ 13 smaller / regional plans $198 - $407
Excludes 5 rental-network / third-party entries (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

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Facility Profile & Credentials

  • Address: 3100 Superior Ave, Sheboygan, WI 53081
  • CMS Rating: ★★★☆☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals