CMS Price Transparency Data

Total knee replacement

Facility: St Nicholas Hospital

Billing Code: 27447 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 27447
  • Insurance Median: $15,528
  • Cash Discount Price: $20,346
  • vs. Medicare Baseline: 1.18x Medicare
The contracted insurance negotiated median rate for a Total knee replacement at St Nicholas Hospital is $15,528. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $20,346. Compared to the federal Medicare reimbursement reference rate of $13,116.76, this hospital’s rate is 1.18x the Medicare baseline. Located in 3100 Superior Ave, Sheboygan, WI.
Cash / Self-Pay
$20,346

Average discount available for prompt cash payment at this facility.

Insurance Median
$15,528

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate
$13,116.76

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $13,116.76 (100%)
Cash / Self-Pay: $20,346 (155%)
Insurance Median: $15,528 (118%)
Cash: $20,346 (155% of Medicare)
Ins. Median: $15,528 (118% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $13,116.76 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.

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 $4,065 - $22,755 31%
Community Care Family Care $4,065 - $6,098 31%
Managed Health Services $4,065 - $6,098 31%
Medicaid / KanCare $4,065 - $6,098 31%
Meridian Health Plan $4,065 - $6,098 31%
Molina Healthcare $4,309 - $12,438 33%
Triology $4,309 - $24,354 33%
P360 Small Group $10,352 - $15,528 79%
Prevea Health Network $10,352 - $15,528 79%
Humana $11,200 - $26,203 85%
UnitedHealthcare $11,592 - $17,388 88%
Aetna $12,438 - $30,828 95%
Medica $12,438 95%
Medicare (plans) $12,438 95%
Security Health Plan $12,562 - $19,677 96%
Molina Healthcare Of Wi $15,414 118%
Hshs Employees $16,709 127%
Arise Health Plan $18,497 141%
Wea Provider Network $19,113 - $22,196 146%
Cigna $21,579 165%
Interplan $21,579 165%
Network Health Plan $21,579 165%
Health Care Alliance $22,504 172%
Health Eos $23,121 176%
Healthsmart $23,121 176%
Wisconsin Physician Service $24,662 188%
Multiplan/Phcs $25,895 197%
Choicecare $26,203 200%
Naphcare $27,985 213%
North Central Healthcare Alliance $28,361 216%
First Health $29,286 223%
Caterpillar, Inc. $30,828 235%
Cofinity $30,828 235%
Live360 $30,828 235%

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