CMS Price Transparency Data

MRI, knee or other leg joint

Facility: St Nicholas Hospital

Billing Code: 73721 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 73721
  • Insurance Median: $1,988
  • Cash Discount Price: $2,421
  • vs. Medicare Baseline: 8.16x Medicare
The contracted insurance negotiated median rate for a MRI, knee or other leg joint at St Nicholas Hospital is $1,988. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,421. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 8.16x the Medicare baseline. Located in 3100 Superior Ave, Sheboygan, WI.
Cash / Self-Pay
$2,421

Average discount available for prompt cash payment at this facility.

Insurance Median
$1,988

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate
$243.77

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $243.77 (100%)
Cash / Self-Pay: $2,421 (993%)
Insurance Median: $1,988 (816%)
Cash: $2,421 (993% of Medicare)
Ins. Median: $1,988 (816% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $243.77 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 816% of the Medicare baseline (a markup of 716%). 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 $103 - $1,611 42%
Community Care Family Care $103 42%
Managed Health Services $103 42%
Medicaid / KanCare $103 42%
Meridian Health Plan $103 42%
Molina Healthcare $110 - $234 45%
Triology $110 - $2,898 45%
Aetna $234 - $3,668 96%
Humana $234 - $3,118 96%
Medica $234 96%
Medicare (plans) $234 96%
UnitedHealthcare $234 - $1,436 96%
Security Health Plan $236 - $2,341 97%
Naphcare $526 216%
P360 Small Group $1,335 548%
Prevea Health Network $1,335 548%
Molina Healthcare Of Wi $1,834 752%
Hshs Employees $1,988 816%
Arise Health Plan $2,201 903%
Wea Provider Network $2,274 - $2,641 933%
Cigna $2,568 1053%
Interplan $2,568 1053%
Network Health Plan $2,568 1053%
Health Care Alliance $2,678 1099%
Health Eos $2,751 1129%
Healthsmart $2,751 1129%
Wisconsin Physician Service $2,934 1204%
Multiplan/Phcs $3,081 1264%
Choicecare $3,118 1279%
North Central Healthcare Alliance $3,375 1385%
First Health $3,485 1430%
Caterpillar, Inc. $3,668 1505%
Cofinity $3,668 1505%
Live360 $3,668 1505%

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