CMS Price Transparency Data

Total hip replacement

Facility: St Nicholas Hospital

Billing Code: 27130 (CPT)

The BaseRate · fair price high confidence

A fair price for this

$15,952

about 1.2× the $13,117 Medicare rate · typically $10,042–$18,461

modeled estimate · not a bill or quote

What this hospital charges insurers

$11,396

Below the fair price — a good deal

about $4,556 under the fair price · 0.9× Medicare

Medicare pays $13,117 Fair price $15,952 This hospital $11,396 Cash price $20,614 Hospital's list price $31,233

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 $2,456 Priciest $11,396

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

A fair price for a Total hip replacement is about $15,952 (about 1.2× the $13,117 Medicare rate). St Nicholas Hospital charges insurers about $11,396, or about $20,614 in cash — below the fair price — a good deal. 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	$11,592 - $12,438	88%
Blue Cross Blue Shieldmajor	$4,065 - $20,859	31%
Aetnamajor	$12,438 - $31,233	95%
Cignamajor	$21,863	167%
Humanamajor	$11,200 - $26,548	85%
Health Net	$10,352	79%
Medica	$12,438	95%
Meridian	$4,065	31%
Molina	$4,309 - $15,617	33%
Security Health Plan	$12,562 - $19,936	96%
+ 15 smaller / regional plans	$4,065 - $31,233

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 20,614), 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: 27130.

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 27130.
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: Total hip replacement at other WI hospitals

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