CMS Price Transparency Data

Screening mammogram (both breasts)

Facility: St Nicholas Hospital

Billing Code: 77067 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 77067
  • Insurance Median: $171
  • Cash Discount Price: $238
  • vs. Medicare Baseline: 1.35x Medicare
The contracted insurance negotiated median rate for a Screening mammogram (both breasts) at St Nicholas Hospital is $171. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $238. Compared to the federal Medicare reimbursement reference rate of $126.25, this hospital’s rate is 1.35x the Medicare baseline. Located in 3100 Superior Ave, Sheboygan, WI.
Cash / Self-Pay
$238

Average discount available for prompt cash payment at this facility.

Insurance Median
$171

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate
$126.25

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $126.25 (100%)
Cash / Self-Pay: $238 (189%)
Insurance Median: $171 (135%)
Cash: $238 (189% of Medicare)
Ins. Median: $171 (135% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $126.25 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.

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 - $470 16%
Community Care Family Care $20 16%
Managed Health Services $20 16%
Medicaid / KanCare $20 16%
Meridian Health Plan $20 16%
Molina Healthcare $22 - $470 17%
Triology $22 - $371 17%
Aetna $77 - $470 61%
Humana $77 - $470 61%
Medica $77 - $470 61%
Medicare (plans) $77 - $470 61%
UnitedHealthcare $77 - $470 61%
Molina Healthcare Of Wi $82 - $235 65%
Security Health Plan $86 - $475 68%
Hshs Employees $88 - $255 70%
Arise Health Plan $98 - $282 78%
P360 Small Group $98 - $282 78%
Prevea Health Network $98 - $282 78%
Wea Provider Network $101 - $338 80%
Cigna $114 - $329 90%
Interplan $114 - $329 90%
Network Health Plan $114 - $329 90%
Health Care Alliance $119 - $343 94%
Health Eos $122 - $352 97%
Healthsmart $122 - $352 97%
Wisconsin Physician Service $130 - $376 103%
Multiplan/Phcs $137 - $395 109%
Choicecare $139 - $400 110%
North Central Healthcare Alliance $150 - $432 119%
First Health $155 - $446 123%
Caterpillar, Inc. $163 - $470 129%
Cofinity $163 - $470 129%
Live360 $163 - $470 129%
Naphcare $192 152%

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