Are you getting ACL surgery such as an ACL reconstruction? Wondering what does ACL replacement surgery cost? As of 2026, the total price typically runs between $20,000 and $50,000 for uninsured patients in the United States. The largest component by far is the hospital or surgical facility charge ($15,000 to $40,000), which covers the operating room, implants, nursing staff, and supplies. The surgeon’s professional fee is set by the Medicare RVU (Relative Value Unit) system and is relatively modest by comparison, typically $600 to $1,500 depending on the payer’s contracted rate. Anesthesia adds $2,000 to $4,500. Most insured patients pay significantly less out-of-pocket, usually $2,500 to $6,000 depending on their plan.
For patients with insurance, out-of-pocket costs in 2026 typically range from $2,500 to $6,000, depending on the deductible, co-insurance rate, and whether the procedure is performed in-network. Verifying coverage with your insurer before scheduling surgery is strongly recommended. Learn more about ACL surgery recovery timelines to plan for time off work and sports.
Total Cost Breakdown: What You Are Actually Paying For
ACL reconstruction involves multiple providers and services, each generating a separate charge. Understanding where the money goes helps patients anticipate bills and negotiate effectively. The major cost components include:
Surgeon’s professional fee (~$600 to $1,500): The surgeon’s fee for ACL reconstruction (CPT 29888) is determined by the Medicare RVU system, not by the individual surgeon. The procedure carries a work RVU of 13.94, and the total facility RVU is approximately 17.67. Multiplied by the 2026 CMS conversion factor of $33.42, this yields a Medicare allowed amount of roughly $590. Commercial insurance contracts typically reimburse at 1.5x to 2.5x the Medicare rate, putting the surgeon’s fee in the range of $885 to $1,475 for most commercially insured patients. This fee includes a 90-day global period covering all routine post-operative follow-up visits.
Facility or hospital charges ($15,000 to $45,000): The surgical facility fee is typically the largest single line item. It covers operating room time, nursing staff, sterile supplies, implants (screws, buttons, or other fixation devices), and recovery room monitoring. Outpatient surgery centers generally cost less than hospital-based operating rooms for the same procedure. Most ACL reconstructions are performed on an outpatient basis, meaning the patient goes home the same day.
Anesthesia ($2,000 to $4,500): ACL reconstruction is typically performed under general anesthesia combined with a peripheral nerve block for post-operative pain control. The anesthesia fee reflects base units for the procedure, time units for the duration of surgery, and the nerve block component. A regional nerve block reduces post-operative pain and opioid use, improving the recovery experience. The total anesthesia charge depends on the duration of the case and the specific techniques used.
Pre-operative imaging and evaluation ($500 to $2,000): Before surgery, patients typically need an MRI ($500 to $1,500) to confirm the diagnosis and assess associated injuries such as meniscus tears or cartilage damage. X-rays, office visits, and a pre-operative medical clearance add to this category.
Post-operative rehabilitation ($1,500 to $5,000): Physical therapy is essential after ACL reconstruction and typically continues for 6 to 9 months. Patients average 2 to 3 sessions per week in the early phases, tapering over time. Insurance usually covers physical therapy with a copay per visit ($20 to $75), but the cumulative cost over dozens of sessions adds up. A post-operative knee brace ($200 to $600) is also standard.
ACL Graft Type Cost Comparison
The following table provides a general comparison of the four most common ACL graft options, including typical cost implications, key advantages, and trade-offs. Actual costs vary by surgeon, facility, and geographic region. The choice of graft should be based on clinical factors specific to each patient, not cost alone.
| Graft Type | Tissue Source | Estimated Added Cost | Key Advantages | Considerations |
|---|---|---|---|---|
| Quadriceps Tendon (Autograft) | Patient’s own quad tendon above the kneecap | No additional tissue cost (autograft) | Strong, versatile graft with bone block option. Increasingly favored by sports medicine specialists for primary ACL reconstruction. | Requires harvest from the patient. Temporary quad weakness during recovery. Dr. Burnham’s preferred graft for most primary ACL reconstructions. |
| Patellar Tendon (Autograft) | Patient’s own patellar tendon (bone-tendon-bone) | No additional tissue cost (autograft) | Bone-to-bone healing. Long track record of clinical success. Strong fixation. | Anterior knee pain and kneeling discomfort are more common. Risk of patellar fracture (rare). |
| Hamstring Tendon (Autograft) | Patient’s own semitendinosus and/or gracilis tendons | No additional tissue cost (autograft) | Smaller incision. Less anterior knee pain compared to patellar tendon. Good for smaller patients. | Soft tissue-to-bone healing (slower). Potential hamstring weakness. Graft size can be variable. |
| Allograft (Donor Tissue) | Cadaver donor (various tissue types available) | $2,000 to $5,000 additional for tissue procurement and processing | No donor site morbidity. Shorter surgery time. Less post-operative pain from graft harvest. | Higher cost due to tissue bank fees. Some studies suggest higher re-tear rates in young, active patients. Best suited for revision surgery, older patients, or multi-ligament reconstruction. |
For most young, active patients undergoing primary ACL reconstruction, autograft options (quadriceps tendon, patellar tendon, or hamstring) are generally recommended due to lower re-tear rates and no additional tissue procurement costs. Allograft tissue adds $2,000 to $5,000 to the total surgical cost but plays an important role in revision cases and multi-ligament knee injuries. The best graft choice depends on the patient’s age, activity level, anatomy, and surgical history. Compare all ACL graft options in detail.
Insurance Coverage and Pre-Authorization
ACL reconstruction is classified as a medically necessary procedure by virtually all commercial insurance plans, Medicare, and Medicaid. Coverage typically includes the surgeon’s fee, anesthesia, facility charges, and implants. However, patients are responsible for their plan’s deductible, co-insurance, and any out-of-network costs.
Most insurers require prior authorization before approving ACL surgery. The typical pre-authorization process involves: submission of MRI findings confirming a complete ACL tear, documentation of functional instability or failed conservative treatment, and the surgeon’s office filing the request with appropriate CPT procedure codes. Processing times range from 48 hours to several weeks depending on the carrier. The surgical coordination team at Ochsner-Andrews Sports Medicine Institute handles prior authorization submissions and can provide a pre-surgical cost estimate based on the patient’s specific plan.
Patients should verify several details before scheduling surgery: whether the surgeon is in-network, whether the surgical facility is in-network (these can differ), the remaining annual deductible balance, the co-insurance percentage after deductible, and the plan’s out-of-pocket maximum. A patient who has already met most of their deductible earlier in the year may pay substantially less than someone scheduling surgery in January.
Out-of-Pocket Costs: Insured vs. Uninsured
With Insurance
For patients with commercial health insurance, the actual out-of-pocket cost for ACL reconstruction typically ranges from $1,500 to $6,000. The primary variables are the plan’s deductible (commonly $1,000 to $3,000 for individual coverage), the co-insurance split after deductible (typically 80/20 or 70/30), and whether the plan has an out-of-pocket maximum that caps total patient responsibility. Patients with high-deductible health plans (HDHPs) may face higher initial costs but can offset these with HSA contributions (discussed below).
Without Insurance
Uninsured patients face the full billed charges, which typically range from $20,000 to $60,000 depending on the facility and geographic region. However, most hospitals and surgery centers offer a self-pay discount (often 20% to 40% off billed charges) for patients who pay upfront or arrange payment before surgery. Patients should ask the billing department directly about cash-pay pricing, as the negotiated rate is often significantly lower than the list price. Some facilities also offer bundled pricing that includes the surgeon, anesthesia, facility, and implants in a single quote.
Financing ACL Surgery
HSA and FSA accounts: ACL reconstruction is a qualifying medical expense under both Health Savings Accounts (HSA) and Flexible Spending Accounts (FSA). Eligible costs include surgeon fees, anesthesia, facility charges, MRI, post-operative bracing, and physical therapy copays. Using pre-tax dollars effectively reduces the total expense by the patient’s marginal tax rate (often 22% to 32%). Patients anticipating surgery should plan HSA/FSA contributions during open enrollment.
Hospital payment plans: Many surgical facilities offer interest-free payment plans that allow patients to spread costs over 6 to 24 months. These plans typically require no credit check for balances under a certain threshold. Patients should ask about payment plan options during the pre-surgical financial consultation.
Medical financing: Third-party medical credit programs (such as CareCredit or Prosper Healthcare Lending) offer promotional interest-free periods (typically 6 to 24 months) for qualified applicants. If the balance is paid in full during the promotional period, no interest accrues. However, patients should be aware that deferred-interest plans charge retroactive interest on the full original balance if not paid in time.
Negotiating a cash-pay rate: Uninsured patients or those with very high deductibles can often negotiate a reduced rate by offering upfront payment. Requesting an itemized estimate and comparing it to Medicare reimbursement rates for the same procedure codes gives patients a data-driven starting point for negotiation.
Factors That Affect Your Total Cost
Several variables can push the total cost of ACL reconstruction higher or lower than the averages quoted above:
Geographic location: Healthcare costs vary significantly by region. Urban medical centers and high cost-of-living areas tend to have higher facility fees. Louisiana generally falls in the moderate range nationally for orthopedic surgery costs.
Surgeon specialization and volume: The surgeon’s professional fee is standardized by payer contracts and RVU-based reimbursement, so choosing a fellowship-trained specialist does not typically increase the surgeon’s charge. However, high-volume ACL surgeons tend to have lower complication rates, shorter operative times, and better functional outcomes, which can reduce the total cost of care over the recovery period by avoiding revision surgery or prolonged rehabilitation.
Associated injuries: Approximately 50% of ACL tears involve concurrent meniscus tears or cartilage injuries. If meniscus repair or cartilage restoration is performed during the same surgery, operative time increases and additional implants may be required, adding $2,000 to $8,000 to the total depending on the complexity.
Outpatient vs. hospital setting: The same procedure performed in a freestanding ambulatory surgery center typically costs 30% to 50% less in facility fees compared to a hospital-based operating room. Most primary ACL reconstructions are appropriate for the outpatient setting.
Revision surgery: Revision ACL reconstruction is more complex than primary surgery, often requiring allograft tissue, bone grafting, staged procedures, or specialized implants. Revision cases typically cost 20% to 50% more than primary reconstruction.
Post-Surgery Costs to Plan For
The surgical bill is not the final expense. Patients should budget for ongoing costs during the 6 to 12 month recovery period:
Physical therapy: The most significant post-operative cost. Patients typically attend 2 to 3 sessions per week for the first 3 months, then 1 to 2 sessions per week for the following 3 to 6 months. With insurance copays of $20 to $75 per visit and 40 to 60 total sessions, out-of-pocket physical therapy costs commonly reach $1,000 to $4,000. The ACL rehabilitation protocol at Ochsner-Andrews is designed to optimize outcomes while keeping visit frequency efficient.
Bracing: A post-operative hinged knee brace ($200 to $600) is standard. Some patients also use a functional sport brace ($300 to $800) when returning to athletics, though this is not universally required.
Follow-up imaging: Routine follow-up X-rays are typically included in the global surgical fee. Some surgeons obtain a follow-up MRI at 6 to 12 months to assess graft healing before clearing patients for full sport, which may generate an additional charge ($300 to $800 with insurance).
Time away from work: While not a direct medical cost, lost wages represent a real financial impact. Most patients with desk jobs return to work within 1 to 2 weeks. Patients with physically demanding occupations may require 3 to 6 months before full duty, depending on job requirements.
FAQ: ACL Surgery Costs
How much does ACL surgery cost in Louisiana in 2026?
In Louisiana, the total cost of ACL reconstruction in 2026 typically ranges from $20,000 to $50,000 for uninsured patients, consistent with the national average. For patients with commercial insurance, out-of-pocket costs generally range from $2,500 to $6,000 depending on the deductible and in-network status of the surgeon and facility. At Ochsner-Andrews Sports Medicine Institute in Baton Rouge, ACL reconstruction is performed at a fully accredited surgical facility. Patients are encouraged to contact the office prior to surgery to verify insurance coverage and obtain a cost estimate.
Does insurance cover ACL reconstruction surgery?
Yes, ACL reconstruction is typically covered by commercial health insurance, Medicare, and Medicaid as a medically necessary procedure, provided the surgery is deemed appropriate based on clinical evaluation. Coverage usually includes the surgeon’s fee, anesthesia, and facility charges, though patients are responsible for deductibles, co-insurance, and any out-of-network costs. Pre-authorization from the insurance company is often required before scheduling surgery. Patients should confirm coverage details directly with their insurer and verify that the surgeon and surgical facility are in-network to minimize out-of-pocket costs.
Can I use my HSA or FSA to pay for ACL surgery?
Yes. ACL reconstruction is a qualifying medical expense under both Health Savings Accounts (HSA) and Flexible Spending Accounts (FSA). Eligible costs typically include surgeon fees, anesthesia, facility charges, pre-operative imaging such as MRI, post-operative bracing, and physical therapy copays. Patients enrolled in a High Deductible Health Plan (HDHP) with an HSA can use pre-tax dollars to cover out-of-pocket costs, which effectively reduces the total expense by the individual’s marginal tax rate. FSA funds follow a use-it-or-lose-it schedule, so patients anticipating ACL surgery should plan contributions during open enrollment. The billing team at Ochsner-Andrews Sports Medicine Institute in Baton Rouge can provide itemized cost estimates to help patients maximize their HSA or FSA benefits.
How does graft choice affect the total cost of ACL surgery?
Graft selection is one of the largest variables in ACL reconstruction cost. Autografts (tissue harvested from the patient’s own body, such as patellar tendon, hamstring tendon, or quadriceps tendon) carry no separate tissue-procurement fee because the graft is obtained during the same procedure. Allografts (donor tissue from a tissue bank) add approximately $2,000 to $5,000 to the surgical cost for tissue processing, testing, and shipping. The choice between graft types depends on the patient’s age, activity level, and surgical history rather than cost alone. Dr. Burnham discusses graft options, expected outcomes, and cost implications during the pre-operative consultation so that each patient can make a fully informed decision. For a detailed comparison, see the ACL reconstruction overview.
What steps should I take to get insurance pre-authorization for ACL surgery?
Most commercial insurance plans require prior authorization before approving ACL reconstruction. The typical process includes: (1) obtaining an MRI confirming an ACL tear, (2) documentation of failed conservative treatment or clinical indication for surgery, (3) submission of a prior authorization request by the surgeon’s office with the appropriate CPT codes, and (4) confirmation of approval before scheduling the procedure. Processing times vary from 48 hours to several weeks depending on the insurer. Patients should verify their plan’s in-network status, deductible balance, and coinsurance percentage before surgery. The surgical coordination team at Ochsner-Andrews Sports Medicine Institute handles prior authorization submissions and can provide a pre-surgical cost estimate based on the patient’s specific plan benefits.
What is the typical out-of-pocket cost for ACL surgery with insurance?
For patients with commercial insurance, out-of-pocket costs for ACL reconstruction typically range from $1,500 to $5,000, depending on the plan’s deductible, coinsurance rate, and out-of-pocket maximum. Patients who have already met a portion of their annual deductible may pay considerably less. The total billed cost for ACL surgery (including surgeon, anesthesia, facility, and implants) generally falls between $20,000 and $50,000 before insurance adjustments. Patients with High Deductible Health Plans may face higher initial costs but can offset these with HSA contributions. Payment plans and financing options are available at Ochsner-Andrews Sports Medicine Institute for patients who need to spread costs over time. Scheduling a consultation is the best first step to obtain a personalized cost estimate.
About the Author
Dr. Jeremy Burnham is a board-certified, fellowship-trained orthopedic surgeon and sports medicine specialist at Ochsner-Andrews Sports Medicine Institute in Baton Rouge, Louisiana. He completed orthopedic residency at the University of Kentucky and sports medicine fellowship at the University of Pittsburgh Medical Center under Drs. Freddie Fu, Volker Musahl, and James Bradley. Dr. Burnham is the most-published ACL surgeon in Louisiana, with 53 peer-reviewed publications, 13 book chapters, and 61 podium and poster presentations.
Clinical focus: ACL reconstruction, complex and revision knee reconstruction, cartilage restoration, meniscus repair, and sports injury care. Full biography · Research and publications
References:
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- Cooper MT, Kaeding C. Comparison of the Hospital Cost of Autograft Versus Allograft Soft-Tissue Anterior Cruciate Ligament Reconstructions. Arthroscopy. 2010;26(11):1523-1527. doi:10.1016/j.arthro.2010.04.004
- Genuario JW, Faucett SC, Boublik M, Schlegel TF. A Cost-Effectiveness Analysis Comparing 3 Anterior Cruciate Ligament Graft Types: Bone-Patellar Tendon-Bone Autograft, Hamstring Autograft, and Allograft. Am J Sports Med. 2012;40(2):307-314. doi:10.1177/0363546511426088
- Mather RC 3rd, Koenig L, Kocher MS, et al. Societal and Economic Impact of Anterior Cruciate Ligament Tears. J Bone Joint Surg Am. 2013;95(19):1751-1759. doi:10.2106/JBJS.L.01705