CMS Price Transparency Data

X-ray, hip

Facility: St Nicholas Hospital

Billing Code: 73502 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 73502
  • Insurance Median: $352
  • Cash Discount Price: $364
  • vs. Medicare Baseline: 3.96x Medicare
The contracted insurance negotiated median rate for a X-ray, hip at St Nicholas Hospital is $352. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $364. Compared to the federal Medicare reimbursement reference rate of $88.91, this hospital’s rate is 3.96x the Medicare baseline. Located in 3100 Superior Ave, Sheboygan, WI.
Cash / Self-Pay
$364

Average discount available for prompt cash payment at this facility.

Insurance Median
$352

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: $364 (409%)
Insurance Median: $352 (396%)
Cash: $364 (409% of Medicare)
Ins. Median: $352 (396% 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 396% of the Medicare baseline (a markup of 296%). 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 - $371 27%
Community Care Family Care $24 - $36 27%
Managed Health Services $24 - $36 27%
Medicaid / KanCare $24 - $36 27%
Meridian Health Plan $24 - $36 27%
Molina Healthcare $26 - $85 29%
Triology $26 - $435 29%
Security Health Plan $34 - $352 38%
Humana $72 - $468 81%
Aetna $85 - $551 96%
Medica $85 96%
Medicare (plans) $85 96%
UnitedHealthcare $85 - $470 96%
Naphcare $192 216%
Molina Healthcare Of Wi $276 310%
Hshs Employees $299 336%
Arise Health Plan $331 372%
Wea Provider Network $342 - $397 385%
Cigna $386 434%
Interplan $386 434%
Network Health Plan $386 434%
Health Care Alliance $402 452%
Health Eos $413 465%
Healthsmart $413 465%
P360 Small Group $422 - $551 475%
Prevea Health Network $422 - $551 475%
Wisconsin Physician Service $441 496%
Multiplan/Phcs $463 521%
Choicecare $468 526%
North Central Healthcare Alliance $507 570%
First Health $523 588%
Caterpillar, Inc. $551 620%
Cofinity $551 620%
Live360 $551 620%

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