An ACL tear is one of the most common sports injuries, and reconstruction surgery costs $20,000–$40,000 at a hospital before insurance. Add 6–9 months of physical therapy, and total costs can reach $28,000–$48,000. But choosing the right setting and understanding your graft options can save thousands. Here’s the complete breakdown.
1. Full cost breakdown
| Component | CPT Code | Hospital Charge | ASC Charge | Medicare Rate |
|---|---|---|---|---|
| Surgeon’s fee (ACL reconstruction) | 29888 | $3,000–$6,000 | $2,500–$4,500 | ~$1,200–$1,600 |
| Anesthesia (2–3 hours) | 01382 | $1,500–$3,000 | $1,000–$2,000 | ~$600–$900 |
| Facility fee | — | $10,000–$20,000 | $5,000–$10,000 | Varies |
| Allograft tissue (if used) | — | $2,000–$5,000 | $2,000–$4,000 | Bundled or separate |
| Pre-op MRI | 73721 | $1,000–$3,000 | — | ~$250–$500 |
| Post-op brace | L1845 | $200–$800 | $200–$600 | ~$100–$250 |
| Post-op medications | Various | $50–$300 | $50–$300 | Part D |
2. Graft types and costs
| Graft Type | Source | Added Cost | Re-tear Rate | Best For |
|---|---|---|---|---|
| Patellar tendon autograft | Your own kneecap tendon | $0 (included) | ~3–5% | Young athletes, high-demand sports |
| Hamstring autograft | Your own hamstring tendon | $0 (included) | ~5–7% | Less anterior knee pain, recreational athletes |
| Quadriceps tendon autograft | Your own quad tendon | $0 (included) | ~4–6% | Revision surgery, larger graft needed |
| Allograft (donor tissue) | Cadaver tissue | $2,000–$5,000 | ~8–12% (higher in young athletes) | Older patients, lower-demand activities, revision |
3. Cost with vs. without insurance
| Coverage | Surgery Cost | Your Out-of-Pocket (surgery only) |
|---|---|---|
| Employer PPO | $20,000–$40,000 billed | $2,000–$6,000 |
| High-deductible (HDHP) | $20,000–$40,000 billed | $3,000–$8,000 (may hit OOP max) |
| Medicare | ~$8,000–$12,000 (Medicare rate) | $1,676 deductible + 20% coinsurance |
| Uninsured (hospital) | $25,000–$45,000 | Full amount (negotiate 40–60% off) |
| Uninsured (ASC) | $12,000–$22,000 | Full amount |
College athlete saves $14,000 by choosing an ASC
A 20-year-old college soccer player in Texas tore her ACL. Her parents’ high-deductible insurance plan had a $5,000 deductible. The hospital quoted $36,000; a sports medicine ASC quoted $18,500 for the same surgeon. At the hospital, she’d pay $5,000 deductible + 20% of $31,000 = ~$11,200. At the ASC, she paid $5,000 deductible + 20% of $13,500 = ~$7,700. Savings: $3,500 out of pocket, and her insurer saved $17,500.
4. Hospital vs. surgery center
| Factor | Hospital | ASC |
|---|---|---|
| Total cost | $20,000–$40,000 | $12,000–$22,000 |
| Savings | — | 35–45% |
| Typical stay | Same-day or 1 night | Same-day (go home 2–4 hours after) |
| Complication rates | Comparable | Comparable |
ACL reconstruction is one of the most commonly performed procedures at orthopedic ASCs. Find one near you: BillKarma Surgery Center Directory.
5. Physical therapy recovery costs
PT is the biggest post-surgical expense and is non-negotiable for a full recovery:
| Phase | Timeline | Frequency | Cost per Session | Subtotal |
|---|---|---|---|---|
| Phase 1: Protection | Weeks 1–6 | 2–3x/week | $130–$200 | $1,560–$3,600 |
| Phase 2: Strengthening | Weeks 6–16 | 2x/week | $130–$200 | $2,600–$4,000 |
| Phase 3: Sport-specific | Months 4–9 | 1–2x/week | $130–$200 | $2,600–$4,800 |
Total PT cost: $3,000–$8,000 (50–70 sessions over 6–9 months). With insurance copays of $30–$75/visit, expect $1,500–$4,500 out of pocket for PT alone. See our physical therapy billing guide for tips on reducing PT costs.
6. 5 ways to lower your ACL surgery bill
a) Choose an ASC
Saves 35–45% on the facility fee. Most ACL reconstructions are done outpatient anyway.
b) Choose autograft over allograft
Saves $2,000–$5,000 in graft costs and has lower re-tear rates for young athletes.
c) Get your MRI at a freestanding imaging center
A knee MRI costs $1,000–$3,000 at a hospital but $300–$700 at a freestanding imaging center. Same machine, same quality. See our imaging center directory.
d) Time surgery strategically
If you’ve already met your deductible this year (from the ER visit or MRI), schedule surgery in the same calendar year. If not, consider whether January surgery (fresh deductible but 12 months of PT in one plan year) or late-year surgery makes more sense.
e) Audit the bill
Common ACL billing errors: duplicate charges for disposable arthroscopic instruments, inflated brace charges, and separate billing for procedures bundled in the primary CPT code. Upload to BillKarma to catch these.
Frequently asked questions
How much does ACL surgery cost without insurance?
$20,000–$40,000 at a hospital, $12,000–$22,000 at an ASC. Add $3,000–$8,000 for 6–9 months of physical therapy.
How much does ACL surgery cost with insurance?
$2,000–$6,000 for the surgery, plus $1,500–$4,500 in PT copays over 6–9 months. Many patients hit their out-of-pocket maximum.
Does insurance cover ACL surgery?
Yes, when medically necessary (documented tear with instability). Prior authorization may be required. Some plans require prehab PT before approving surgery.
What is the cost difference between autograft and allograft?
Allograft adds $2,000–$5,000 for donor tissue. Autograft (your own tissue) is included in the surgery cost. For athletes under 25, autograft has lower re-tear rates and is cheaper.
How much does physical therapy cost after ACL surgery?
$3,000–$8,000 total for 50–70 sessions over 6–9 months. With insurance copays of $30–$75/visit, expect $1,500–$4,500 out of pocket.