CMS Price Transparency Data

X-ray, lower back

Facility: St Nicholas Hospital

Billing Code: 72110 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 72110
  • Insurance Median: $442
  • Cash Discount Price: $583
  • vs. Medicare Baseline: 4.14x Medicare
The contracted insurance negotiated median rate for a X-ray, lower back at St Nicholas Hospital is $442. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $583. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 4.14x the Medicare baseline. Located in 3100 Superior Ave, Sheboygan, WI.
Cash / Self-Pay
$583

Average discount available for prompt cash payment at this facility.

Insurance Median
$442

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: $583 (546%)
Insurance Median: $442 (414%)
Cash: $583 (546% of Medicare)
Ins. Median: $442 (414% 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 414% of the Medicare baseline (a markup of 314%). 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 - $160 22%
Community Care Family Care $24 22%
Managed Health Services $24 22%
Medicaid / KanCare $24 22%
Meridian Health Plan $24 22%
Molina Healthcare $26 - $103 24%
Triology $26 - $698 24%
Security Health Plan $42 - $564 39%
Humana $77 - $751 72%
Aetna $103 - $883 96%
Medica $103 96%
Medicare (plans) $103 96%
UnitedHealthcare $103 - $470 96%
Naphcare $231 216%
P360 Small Group $422 395%
Prevea Health Network $422 395%
Molina Healthcare Of Wi $442 414%
Hshs Employees $479 448%
Arise Health Plan $530 496%
Wea Provider Network $547 - $636 512%
Cigna $618 579%
Interplan $618 579%
Network Health Plan $618 579%
Health Care Alliance $645 604%
Health Eos $662 620%
Healthsmart $662 620%
Wisconsin Physician Service $706 661%
Multiplan/Phcs $742 695%
Choicecare $751 703%
North Central Healthcare Alliance $812 760%
First Health $839 786%
Caterpillar, Inc. $883 827%
Cofinity $883 827%
Live360 $883 827%

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