State-level hospital files
Knee replacement cost in Wisconsin: hospital cash price vs insurance
What Wisconsin hospitals publish for a Knee replacement in their own standard-charge files, per billing code, beside what Medicare pays nationally.
What is priced: The inpatient stay is not priced here. When a joint replacement is done as an inpatient stay, hospitals price the stay as a whole under an inpatient case group, not under this billing code, and those figures are not read. The hospital figures on this page are the lines hospitals list under this code that are not marked inpatient-only; a line may be marked for both settings.
What hospitals publish for a Knee replacement, by billing code
Read from each hospital’s standard-charge file, which federal rules (45 CFR 180.50) require it to publish. One figure per hospital and code, the hospital’s facility charge. A median is given only where at least 4 hospitals publish; below that each hospital is named with its own figure. Cash prices and negotiated rates are never combined, and no insurer is named.
1 of 5 hospitals in our source registry for Wisconsin publish a figure for these codes in the files read.
Across all procedures: 183 of 238 hospitals, 51 of 51 states.
| Code | Hospital cash price | Hospital negotiated rates | What Medicare pays (national) |
|---|---|---|---|
| 27447Total knee replacement | Not published in the files read | Published by 1 hospitalToo few for a median; listed by name below | $9,393.16Surgical center facility rate |
The negotiated figure for each hospital is the middle of the rates it lists across its payers. It is what an insurer pays the hospital, not what a patient on that plan pays. The lowest and highest figures are single hospitals’ and are shown so they can be checked against the file.
Code 27447: every hospital and its file
| Hospital | Cash price | Negotiated (middle; no payer named) | File, read |
|---|---|---|---|
| Aurora St. Luke's Medical CenterMilwaukee, WI | Not counted | $21,80514 payers | sthpiprd.blob.core.windows.netread 2026-11-06; file dated 2026-11-05 |
How each route pays for a Knee replacement in Wisconsin
| Route | What it covers | Wait | Price | Source |
|---|---|---|---|---|
| Original Medicare (Part B)Code 27447: Total knee replacement | After the Part B deductible, the patient usually pays 20% of the Medicare-approved amount.Where the provider accepts the Medicare-approved amount as full payment. The deductible is in the Medicare table below. | Not publishedNo official US source publishes waiting times for this procedure. | $9,393.16What Medicare pays. National rate paid to an ambulatory surgical center for the facility. The physician is paid separately (see the Medicare table). |
|
| MedicaidSet by each state | Not trackedEach state sets what its Medicaid program covers and pays. State Medicaid fee schedules have not been read. | Not publishedNo official US source publishes waiting times for this procedure. | Not tracked | None for this row |
| Employer or Marketplace health planCode 27447: Total knee replacement. Hospital negotiated rates, no payer named | A Marketplace plan caps in-network out-of-pocket costs at $10,600 for an individual (plan year 2026).Premiums, services the plan does not cover and out-of-network care do not count toward it. | Not publishedNo official US source publishes waiting times for this procedure. | Published by 1 hospital, too few for a medianThe floor is 4. Each hospital and its figure are listed below. |
|
| Self-pay at a hospitalCode 27447: Total knee replacement. Discounted cash price | Uninsured and self-pay patients are entitled to a Good Faith Estimate of expected charges when they schedule or ask. | Not publishedNo official US source publishes waiting times for this procedure. | Not publishedNo hospital file read publishes a single figure for this code. |
|
| Self-pay at a surgical center or clinicPrices on the provider’s own site | Not tracked | Not publishedNo official US source publishes waiting times for this procedure. | Not trackedNo surgical center’s or clinic’s own price page has been read. | None for this row |
What Medicare pays for a Knee replacement
This is what Medicare pays under its national fee schedule, before geographic adjustment. It is not a price charged to patients or to anyone without Medicare.
| Code | Surgical center facility rate | Physician, in a facility | Physician, in an office |
|---|---|---|---|
| 27447Total knee replacement | $9,393.16 | $1,159.35 | No national amount |
Physician amounts: CMS Physician Fee Schedule, relative value file RVU26D, released August 26, 2026, read October 26, 2026. Computed by CMS’s formula with the file’s own conversion factor, before geographic adjustment.
Surgical center rates: CMS ambulatory surgical center rates, Addendum AA (October 2026), effective October 1, 2026, read October 26, 2026.
Not shown: what Medicare pays a hospital outpatient department. CMS publishes those rates (October 2026 Addendum B) only behind the AMA CPT licence agreement, which this site has not accepted; last checked November 6, 2026.
NOTE 3: The Medicare program payment is 80 percent of the total payment amount and beneficiary coinsurance is 20 percent of the total payment amount except for most preventive services. Sections 4104 and 10406 of the Affordable Care Act (ACA) waive coinsurance and the Part B deductible for most preventive services. These preventive services are identified with a double asterisk (**). (CMS, Addendum AA, quoted as published.)
The patient’s share under Original Medicare
Original Medicare Part B has an annual deductible, paid once a year before Medicare starts to pay. It is $283 (Calendar year 2026). CMS: 2026 Medicare Parts A & B Premiums and Deductibles, read October 26, 2026.
After the Part B deductible, the patient usually pays 20% of the Medicare-approved amount for each covered service, where the provider accepts that amount as full payment. Medicare.gov: Medicare costs, read October 26, 2026.
Arithmetic, not a bill: 20% of the national surgical center rate for code 27447 ($9,393.16) is $1,878.63, before geographic adjustment and the deductible, and excluding the physician’s separate bill.
Medicare Advantage plans set their own cost-sharing; this site does not name or price any plan. Plan choice is explained on Medicare.gov.
Paying yourself: the Good Faith Estimate
Providers and facilities must give uninsured and self-pay patients a Good Faith Estimate of expected charges when a service is scheduled or on request.
“This section sets forth requirements for health care providers and health care facilities related to the issuance of good faith estimates of expected charges for uninsured (or self-pay) individuals (or their authorized representatives), upon request or upon scheduling an item or service.”
Ask for the estimate in writing when you book, and ask whether it covers the separate physician, radiology, anesthesia and pathology bills.
eCFR: 45 CFR 149.610, In force (45 CFR 149.610, text as of 2026-10-01), read October 26, 2026.
Calculator
Cash quote or insurance share for a Knee replacement?
Enter the quote you were given and your own plan figures. Every field starts empty: the tool uses only what you type, or a sourced figure you choose to copy in.
Enter a cash quote and your plan’s allowed amount to see the comparison.
The insurance share is the deductible still to pay (up to the allowed amount), plus your coinsurance on the rest, plus any copay, capped at the out-of-pocket limit you entered. It does not check network status, prior authorization, separately billed physician, radiology, anesthesia or pathology fees, or whether a cash payment counts toward your deductible.
Help the dataset
A written quote or an explanation of benefits you have received helps other readers. Useful submissions include billing code, facility charge, professional fee, provider name, date quoted and whether the amount was a cash price, an allowed amount, your share on an explanation of benefits, or a billed charge.
Before booking, ask
Provider
- What billing code will be used for this Knee replacement?
- Is the cash quote complete, or are professional or facility fees separate?
- Is contrast, anesthesia, pathology or follow-up included if relevant?
- Can you provide the quote in writing before booking?
- Will the operation be billed as inpatient or outpatient?
- Which billing code will be used?
Insurer
- Is the provider in-network for my exact plan?
- Will this billing code require prior authorization?
- What patient responsibility do you estimate after deductible, copay and coinsurance?
- If I pay cash, can I submit a claim afterwards, and would it count toward my deductible?
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What a Wisconsin quote should name
A quote you can compare names the provider, the city, the billing code, the cash price or your plan’s allowed amount, the date, and whether professional, facility, contrast, anesthesia or pathology fees are separate.
Sources
- Hospital standard-charge files (1 hospitals, each file linked below). Read 6 November 2026. Discounted cash prices and negotiated rates, published under 45 CFR 180.50.
- CMS Physician Fee Schedule, relative value file RVU26D, released August 26, 2026. Read 26 October 2026. What Medicare pays a clinician, national amount.
- CMS ambulatory surgical center rates, Addendum AA (October 2026), effective October 1, 2026. Read 26 October 2026. What Medicare pays an ambulatory surgical center, national rate.
- CMS: 2026 Medicare Parts A & B Premiums and Deductibles, Calendar year 2026. Read 26 October 2026. Medicare Part B annual deductible
- Medicare.gov: Medicare costs, In force (statutory share; not set annually). Read 26 October 2026. Medicare Part B coinsurance
- HealthCare.gov glossary: out-of-pocket maximum/limit, Plan year 2026. Read 26 October 2026. Marketplace out-of-pocket limit, individual
- eCFR: 45 CFR 149.610, In force (45 CFR 149.610, text as of 2026-10-01). Read 26 October 2026. Good Faith Estimate for uninsured or self-pay patients