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WI price data · 60 hospitals

Total knee replacement cost in WI

What a total knee replacement costs at WI hospitals — and the fair price to aim for.

Pillar 1 · The BaseRate™ CompositeHow 1.00× Fair BaseRate Works: Raw price averages unfairly penalize hospitals in high-wage cities or trauma centers treating sicker patients. We adjust for local CMS hospital wage levels and patient complexity first. A 1.00× score means right at the fair price average, 0.85× means 15% cheaper than fair market, and 1.30× means 30% above fair market.Above Fair Market · Negotiate
1.10×vs. Fair Market Price
Position vs. 1.00× Fair Price+10% Above Fair Price 1.00× (center of the bar) is the U.S. fair price average after accounting for local hospital wages and patient complexity. Left of center (<1.00×) is below fair price; right of center (>1.00×) is above fair price.

Typical commercial prices here are +10% above the fair benchmark (1.10×) even after accounting for local nurse/doctor wages and patient complexity.

Pillar 2 · VeriRate™ Data TrustHow VeriRate™ (0–100) Works: Hospitals are legally required to publish machine-readable price files, but some bury fake $0.01 numbers or omit cash discounts. VeriRate audits each file across 5 checks (hover any badge below to see what it tests).86/100 · Verified
86/100Hover Any Check Below to See How Prices Were Audited
File Completeness90Provenance (File Completeness): Checks whether the hospital published a complete, up-to-date machine-readable price file with valid CPT and MS-DRG billing codes instead of leaving blanks.
Price Logic88Coherence (Price Logic): Checks whether the hospital’s numbers make basic sense — e.g., self-pay cash price is lower than gross list price, with no fake $0.01 or $999,999 placeholder numbers.
Peer Alignment86Concordance (Peer Alignment): Checks whether reported prices sit in a realistic range compared to Medicare and nearby hospitals rather than wild 100× unit errors.
Clean Billing83Regularity (Clean Billing): Checks whether rates are structured consistently across procedures without erratic statistical spikes or hidden unbundled facility fees.
Real Cash Discount84Cash Honesty (Real Cash Discount): Checks whether the hospital offers a genuine self-pay cash discount that beats or matches commercial insurance rates instead of billing full sticker price.
Pillar 3 · Clinical Quality & ER SpeedChecks whether higher hospital prices actually buy better clinical quality — combining CMS Star Ratings, hospital safety scores, and emergency room wait times.Regional Quality Benchmark
CMS Star RatingNot RatedOfficial CMS Overall Hospital Quality Star Rating (1 to 5 stars) summarizing mortality, safety of care, readmissions, and patient experience.
Safety ScoreNot ScoredComposite patient safety score (0–100) derived from CMS hospital-acquired infection rates (CLABSI, CAUTI, MRSA, C. diff), surgical complications, and HCAHPS surveys.
Typical ER WaitNo ER DataMedian minutes patients spent in the emergency department before leaving from the visit, as reported to CMS Timely and Effective Care.

Balances commercial hospital prices against CMS clinical safety, infection control, and patient experience.

Behavioral Pricing FingerprintConsistent Department Multiples

Aligned Regional Benchmark Peer

Upland Hills Health prices shoppable and inpatient services (1.1× to 1.1× Medicare, divergence 1.00×) in alignment with regional hospital peers (1.04× Fair BaseRate). Reviewing plan-specific negotiated rates and cash discounts helps lock in the lowest out-of-pocket tier.

#24 of 99 in WI · 23rd State Percentile#1,485 of 3,385 in U.S. · 43rd National Percentile
Advantage

Where They're Good (Patient & Payer Edge)

  • Bottom-quartile procedures (Q25) price at 0.72× the peer BaseRate benchmark
  • Self-pay cash beats commercial insurance on 67% of shoppable procedures (99/100 Cash Honesty)
  • 4-Star CMS clinical rating with 86% patient recommendation (82/100 safety score)
  • IRS 501(c)(3) charity care provides free care up to 200% FPL and discounted care up to 400% FPL (37.0% AGB cap)
Watchout

Where You Can Get Burned (Markup Traps)

  • Even at low-cost facilities (1.10× Fair BaseRate), out-of-network or unnegotiated chargemaster bills can exceed commercial medians — confirm in-network status or request a self-pay cash quote up front.
  • Commercial insurance median sits at 0.99× Fair BaseRate (1.1× Medicare), so insured patients should always compare the self-pay cash price before paying.
  • Upper-quartile procedures (Q75 1.25×) jump +26% above the median procedure ratio (Q50 0.99×)
  • Consolidated metro market (HHI 2,886) limits in-network hospital competition (Highly Concentrated Monopoly (>2,500))
Front-Door ShoppableElective / Imaging
1.1× Medicare

Pre-scheduled outpatient procedures where patients can comparison-shop.

Back-Door Captive & ER1.00× Divergence
1.1× Medicare

Emergency, inpatient DRG, lab, and specialty drug lines billed after admission.

Quantile Tail Spread+26% Upper Tail
Q25 0.72× · Q50 0.99× · Q75 1.25×

Detects median-gaming when upper-quartile codes spike above the p50 median.

Select any lens to inspect department markups, federal cost accounting, or insurer discounts.
Department & Integrity Multiples (vs. CMS Medicare Cost Anchor) Green ≤1.3× · Teal 1.3–1.8× · Amber 1.8–2.5× · Rose >2.5×
Front-Door Shoppable CareFront-Door Shoppable
1.1× MedicareGood
Outpatient Surgery & ORBack-Door Captive
0.5× MedicareGood
Diagnostic Imaging (CT/MRI)Front-Door Shoppable
0.7× MedicareGood
Back-Door Captive ER VisitsBack-Door Captive
0.6× MedicareGood
Inpatient Lab & PathologyBack-Door Captive
0.9× MedicareGood
Specialty & Infusion Drugs (J-Codes)Back-Door Captive
0.6× MedicareGood
Self-Pay Cash Honesty & 501(r)Integrity & Outcomes
67% Cash Edge · 99/100Good
CMS Clinical Safety & Star ValueIntegrity & Outcomes
4 CMS · 82/100Good
The BaseRate · WI 60 hospitals
Fair price · the BaseRate
$15,096
what it should cost in WI
Typically charged
$14,891
median across WI hospitals

In general, WI hospitals charge about the fair price for this. how we calculate the BaseRate →

modeled estimate · not a bill or quote

Compared with the rest of the country, WI’s fair BaseRate ($15,096) is above the national fair price of $13,081.

Cheapest WI hospitals for a total knee replacement

Inline Bill X-Ray & 501(r) Calculator 501(c)(3) Nonprofit · Free Care ≤200% FPL · AGB Cap 36.3%

Audit a Bill or Quote at WI Hospital Benchmark (Zero PHI Required)

Fair BaseRate™ $15,096
Medicare Rate $8,756
Self-Pay Cash Request Quote
Insurer Median $14,891
Pre-filled with WI Hospital Benchmark’s charged/list benchmark
Screened against 2026 HHS Federal Poverty Guidelines
2026 FPL: $15,650 + $5,500 per additional person
Step 1 · 501(r) Charity Care Check 501(r) AGB Cap: $12,973 (274% FPL)

Statutory 501(r) AGB Cap Limits Bill to $12,973

At 274% FPL (201%–400% FPL tier), 26 U.S.C. § 501(r)(5) caps FAP-eligible bills at Amounts Generally Billed (36.3% of gross = $12,973).

Step 2 · Cash vs. Insurance Arbitrage Request Prompt-Pay Quote

Compare Prompt-Pay Cash Rate Against Remaining Deductible

Ask WI Hospital Benchmark's billing desk for their written 45 CFR § 180 discounted self-pay cash price and Good Faith Estimate under the No Surprises Act.

Step 3 · Fair BaseRate Target +$20,642 Above Fair BaseRate

Negotiate Toward $15,096 Fair BaseRate ($8,756 Medicare)

Your bill ($35,738) is $20,642 above the denoised Fair BaseRate ($15,096) and 4.1× the $8,756 Medicare rate.

1-Click Factual Dispute Summary: Copy a citation-backed benchmark memo (with CMS CCN, CPT code, Medicare reference, Fair BaseRate, and 26 U.S.C. § 501(r) calculations) to paste into patient-portal messages or billing appeals.
Care-Setting Arbitrage, Bilateral SVD Insurer Leverage & Regional Alternatives

How to Pay Less Nearby: Freestanding Centers, Insurer Leverage & Outpatient Savings

Inpatient MS-DRG vs. Outpatient CPT Care-Setting Savings

Total Knee Arthroplasty (Replacement)DRG 470 vs CPT 27447
Inpatient: $51,826Outpatient: $16,444 Save $35,382 outpatient

Clinical Scope Note:Inpatient MS-DRG reflects a multi-day hospital admission (room, nursing, higher clinical acuity); outpatient CPT reflects the outpatient facility fee for clinically eligible low-acuity patients and excludes separate surgeon and anesthesia professional fees.

Total knee replacement cost nationally → All WI hospital prices →