CMS Price Transparency Data

MRI, knee or other leg joint

Facility: St Nicholas Hospital

Billing Code: 73721 (CPT)

The BaseRate · fair price medium confidence

A fair price for this

$318

about 1.3× the $244 Medicare rate · typically $236–$742

modeled estimate · not a bill or quote

What this hospital charges insurers

$381

Above the fair price

about $63 over the fair price · 1.6× Medicare

Medicare pays $244 Fair price $318 This hospital $381 Cash price $2,421 Hospital's list price $3,668

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 $69 Priciest $381

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

⚠ The cash price looks unusually high next to the insurance price — it may be the full list price, not a real cash discount. Call to confirm the self-pay rate.

A fair price for a MRI, knee or other leg joint is about $318 (about 1.3× the $244 Medicare rate). St Nicholas Hospital charges insurers about $381, or about $2,421 in cash — above the fair price. Located in Sheboygan, WI.

This price is above the fair BaseRate — you may be able to pay less

Ask the hospital for the cash / self-pay price, check whether you qualify for financial assistance, or negotiate the bill down toward the fair price of about $318. Many patients pay well below the first number they’re quoted — the checklists below walk you through it.

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	$233 - $1,513	96%
Blue Cross Blue Shieldmajor	$103 - $1,611	42%
Aetnamajor	$233 - $3,668	96%
Cignamajor	$2,568	1053%
Humanamajor	$233 - $3,118	96%
Health Net	$1,335 - $1,444	548%
Medica	$233 - $234	96%
Meridian	$103 - $107	42%
Molina	$110 - $1,834	45%
Security Health Plan	$236 - $2,341	97%
+ 15 smaller / regional plans	$103 - $3,668

Government programs also on file: Medicare, Medicaid.

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 2,421), 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 CPT code on your bill matches exactly: 73721.

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 CPT code 73721.
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: MRI, knee or other leg joint at other WI hospitals

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