CMS Price Transparency Data

Ultrasound, abdomen (limited)

Facility: St Nicholas Hospital

Billing Code: 76705 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 76705
  • Insurance Median: $526
  • Cash Discount Price: $578
  • vs. Medicare Baseline: 4.92x Medicare
The contracted insurance negotiated median rate for a Ultrasound, abdomen (limited) at St Nicholas Hospital is $526. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $578. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 4.92x the Medicare baseline. Located in 3100 Superior Ave, Sheboygan, WI.
Cash / Self-Pay
$578

Average discount available for prompt cash payment at this facility.

Insurance Median
$526

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: $578 (541%)
Insurance Median: $526 (492%)
Cash: $578 (541% of Medicare)
Ins. Median: $526 (492% 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 492% of the Medicare baseline (a markup of 392%). 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
Molina Healthcare $41 - $103 38%
Security Health Plan $42 - $559 39%
Blue Cross Blue Shield $47 - $696 44%
Community Care Family Care $47 44%
Managed Health Services $47 44%
Medicaid / KanCare $47 44%
Meridian Health Plan $47 44%
Triology $50 - $692 47%
Aetna $103 - $876 96%
Humana $103 - $745 96%
Medica $103 96%
Medicare (plans) $103 96%
UnitedHealthcare $103 - $545 96%
Naphcare $231 216%
Molina Healthcare Of Wi $438 410%
Hshs Employees $475 445%
P360 Small Group $482 451%
Prevea Health Network $482 451%
Arise Health Plan $526 492%
Wea Provider Network $543 - $631 508%
Cigna $613 574%
Interplan $613 574%
Network Health Plan $613 574%
Health Care Alliance $639 598%
Health Eos $657 615%
Healthsmart $657 615%
Wisconsin Physician Service $701 656%
Multiplan/Phcs $736 689%
Choicecare $745 698%
North Central Healthcare Alliance $806 755%
First Health $832 779%
Caterpillar, Inc. $876 820%
Cofinity $876 820%
Live360 $876 820%

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