CMS Price Transparency Data

X-ray, chest (single view)

Facility: St Nicholas Hospital

Billing Code: 71045 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 71045
  • Insurance Median: $213
  • Cash Discount Price: $259
  • vs. Medicare Baseline: 2.40x Medicare
The contracted insurance negotiated median rate for a X-ray, chest (single view) at St Nicholas Hospital is $213. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $259. Compared to the federal Medicare reimbursement reference rate of $88.91, this hospital’s rate is 2.40x the Medicare baseline. Located in 3100 Superior Ave, Sheboygan, WI.
Cash / Self-Pay
$259

Average discount available for prompt cash payment at this facility.

Insurance Median
$213

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate
$88.91

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $88.91 (100%)
Cash / Self-Pay: $259 (291%)
Insurance Median: $213 (240%)
Cash: $259 (291% of Medicare)
Ins. Median: $213 (240% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $88.91 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 240% of the Medicare baseline (a markup of 140%). 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 $24 - $85 27%
Community Care Family Care $24 27%
Managed Health Services $24 27%
Medicaid / KanCare $24 27%
Meridian Health Plan $24 27%
Molina Healthcare $26 - $85 29%
Triology $26 - $310 29%
Humana $34 - $334 38%
Aetna $77 - $393 87%
Medica $77 - $85 87%
Medicare (plans) $77 - $85 87%
Security Health Plan $77 - $251 87%
UnitedHealthcare $77 - $393 87%
Naphcare $192 216%
Molina Healthcare Of Wi $196 220%
Hshs Employees $213 240%
Arise Health Plan $236 265%
Wea Provider Network $244 - $283 274%
Cigna $275 309%
Interplan $275 309%
Network Health Plan $275 309%
Health Care Alliance $287 323%
Health Eos $295 332%
Healthsmart $295 332%
Wisconsin Physician Service $314 353%
Multiplan/Phcs $330 371%
Choicecare $334 376%
North Central Healthcare Alliance $362 407%
First Health $373 420%
Caterpillar, Inc. $393 442%
Cofinity $393 442%
Live360 $393 442%
P360 Small Group $393 442%
Prevea Health Network $393 442%

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