CMS Price Transparency Data

X-ray, chest (two views)

Facility: St Nicholas Hospital

Billing Code: 71046 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 71046
  • Insurance Median: $209
  • Cash Discount Price: $276
  • vs. Medicare Baseline: 2.35x Medicare
The contracted insurance negotiated median rate for a X-ray, chest (two views) at St Nicholas Hospital is $209. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $276. Compared to the federal Medicare reimbursement reference rate of $88.91, this hospital’s rate is 2.35x the Medicare baseline. Located in 3100 Superior Ave, Sheboygan, WI.
Cash / Self-Pay
$276

Average discount available for prompt cash payment at this facility.

Insurance Median
$209

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: $276 (310%)
Insurance Median: $209 (235%)
Cash: $276 (310% of Medicare)
Ins. Median: $209 (235% 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 235% of the Medicare baseline (a markup of 135%). 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 - $95 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 - $330 29%
Security Health Plan $34 - $267 38%
Humana $45 - $355 51%
Aetna $77 - $418 87%
Medica $77 - $85 87%
Medicare (plans) $77 - $85 87%
UnitedHealthcare $77 - $418 87%
Naphcare $192 216%
Molina Healthcare Of Wi $209 235%
Hshs Employees $227 255%
Arise Health Plan $251 282%
Wea Provider Network $259 - $301 291%
Cigna $293 330%
Interplan $293 330%
Network Health Plan $293 330%
Health Care Alliance $305 343%
Health Eos $314 353%
Healthsmart $314 353%
Wisconsin Physician Service $334 376%
Multiplan/Phcs $351 395%
Choicecare $355 399%
North Central Healthcare Alliance $385 433%
First Health $397 447%
Caterpillar, Inc. $418 470%
Cofinity $418 470%
Live360 $418 470%
P360 Small Group $418 470%
Prevea Health Network $418 470%

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