CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: St Nicholas Hospital

Billing Code: 470 (MS-DRG)

The BaseRate · fair price high confidence

A fair price for this

$26,869

about 1.9× the $14,044 Medicare rate · typically $17,435–$30,490

modeled estimate · not a bill or quote

What this hospital charges insurers

$27,969

About the fair price

about $1,100 over the fair price · 2.0× Medicare

Medicare pays $14,044 Fair price $26,869 This hospital $27,969 Cash price $34,850 Hospital's list price $52,804

How we calculate the fair BaseRate →

How this hospital compares to other WI hospitals

Highest price of the 9 WI hospitals we have prices for — worth calling around.

Cheapest $13,222 Priciest $27,969

Black dot = this hospital, among the 9 WI hospitals with a price for this procedure. Full list below.

A fair price for a Hip or knee replacement (inpatient stay) is about $26,869 (about 1.9× the $14,044 Medicare rate). St Nicholas Hospital charges insurers about $27,969, or about $34,850 in cash — about the fair price. Located in Sheboygan, WI.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

5 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Cigna✓ Humana Kaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$14,591 - $33,031	104%
Blue Cross Blue Shieldmajor	$14,591 - $42,675	104%
Aetnamajor	$14,591 - $52,804	104%
Cignamajor	$36,963	263%
Humanamajor	$14,591 - $44,883	104%
Health Net	$27,969	199%
Medica	$14,591	104%
Molina	$14,591 - $26,402	104%
Security Health Plan	$14,737 - $33,705	105%
+ 13 smaller / regional plans	$23,694 - $52,804

Government programs also on file: Medicare.

Excludes 6 rental-network / third-party entries (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price (about 34,850), before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the MS-DRG code on your bill matches exactly: 470.

Insurance Before you use insurance

Call your insurance company to confirm St Nicholas Hospital is in-network.
Ask your insurer whether prior approval is required for MS-DRG code 470.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at St Nicholas Hospital

Compare: Hip or knee replacement (inpatient stay) at other WI hospitals

Orthopaedic Hospital of Wisconsin · Glendale $13,222
Thedacare Regional Medical Center - Appleton Inc · Appleton $13,348
Sauk Prairie Hospital · Prairie Du Sac $13,634
Oakleaf Surgical Hospital · Altoona $13,660
The Monroe Clinic · Monroe $13,719
Mile Bluff Medical Center · Mauston $13,872
Ascension Sacred Heart Rehabilitation Hospital · Mequon $15,202
Ascension Columbia St Marys Hospital Milwaukee · Milwaukee $15,215

Insurance negotiated median for the same procedure, sorted lowest first.