A torn ACL is a young person’s injury with an older person’s price tag. The operation itself is same-day arthroscopic surgery, usually a couple of hours, and almost nobody stays overnight. The bill is complicated anyway, because ACL reconstruction gets sold in four completely different ways: as a hospital outpatient encounter with separate facility, surgeon, anesthesia, and implant charges, as a single all-inclusive bundle at an ambulatory surgery center, as a prepaid package on a marketplace like MDsave, and as a Medicare rate that no uninsured patient will ever actually be charged.
This guide separates those out using figures verified in September 2026. The one thing worth understanding before you make a single phone call: the surgeon is paid the same either way, and the facility is not. That single line item is where most of the price difference lives.
What Does ACL Surgery Cost Without Insurance?
The relevant code is CPT 29888, arthroscopically aided anterior cruciate ligament repair, augmentation, or reconstruction. Here is what that code costs across every source we could verify.
| Service / price type | Low | Average | High |
|---|---|---|---|
| Bundled surgery center cash price, ACL reconstruction | $7,931 | $12,180 | $15,500 |
| Medicare 2026 national avg, 29888, surgery center | n/a | $5,706 | n/a |
| Medicare 2026 national avg, 29888, hospital outpatient | n/a | $8,302 | n/a |
| MDsave prepaid, ACL repair or reconstruction | $1,430 | $13,814 | $19,969 |
| Sidecar Health cash data, surgery center (state averages) | $6,269 | n/a | $8,913 |
| Newport self-pay, ACL with allograft | n/a | $13,440 | n/a |
| Newport self-pay, ACL plus meniscal repair | n/a | $13,915 | n/a |
| Knee MRI without contrast, published self-pay | n/a | $900 | n/a |
| Orthopedic initial knee evaluation, published self-pay | n/a | $355 | n/a |
| Physical therapy, per visit | $42 | $118 | $179 |
The bundled surgery center prices come from published self-pay lists, not estimates. Surgery Center of Oklahoma posts $7,931 all-inclusive for CPT 29888, covering the surgeon, the facility, anesthesia, the graft, and routine follow-up, with a separate $250 consultation fee. Surgery Center of Allentown posts $11,091.70 for the same code, including facility, physician, anesthesia, and pathology fees. Newport Orthopedic Institute posts $12,180 for an arthroscopic ACL repair or reconstruction at its Newport Beach surgery center and $13,440 with an allograft. ATX Orthopedics in Austin posts $15,500 for 29888 with an allograft, a list it last updated in May 2026.
The Medicare figures come from the CMS Procedure Price Lookup tool, which shows 2026 national averages for both settings side by side. They are not what a self-pay patient is charged, but they are the cleanest apples-to-apples measure of what the setting alone is worth.
The MDsave range is the widest and the least useful as a target. Its $1,430 floor almost certainly reflects a partial component of the episode rather than a full reconstruction, while its $19,969 ceiling and $13,814 national average sit in the same neighborhood as the surgery center bundles. Sidecar Health’s cash-price data, which is surgery-center-only for this procedure, runs from $6,269 in Iowa to $8,913 in Alaska.
What Drives the Price
Surgery center versus hospital outpatient department
This is the biggest lever you control. Under 2026 Medicare national averages, the surgeon is paid $889 for CPT 29888 regardless of where the operation happens. The facility is paid $4,817 at an ambulatory surgery center and $7,413 at a hospital outpatient department, which pushes the total from $5,706 to $8,302. A Medicare patient’s own share goes from $1,140 to $1,659 for identical work by the same surgeon.
Cash prices follow the same slope, which is why every published bundle in the table above comes from a surgery center rather than a hospital. If your surgeon operates at both a hospital and an ASC, asking which one your case is booked at is the single highest-value question you can ask before scheduling.
Graft type
Your ACL is replaced with tissue, either from your own body (an autograft, usually hamstring or patellar tendon) or from a donor (an allograft). The published price gap is real but modest. Newport Orthopedic Institute lists an arthroscopic ACL repair or reconstruction at $12,180 and the same operation with an allograft at $13,440, a difference of $1,260. ATX Orthopedics quotes only the allograft version, at $15,500. Surgery Center of Oklahoma states that the graft is included in its single $7,931 price either way.
Graft choice is a clinical conversation about your age, your sport, and your surgeon’s judgment. It is worth knowing the price difference so it does not surprise you on a quote, and worth not letting a $1,260 line item drive a decision about your knee.
Whether implants and the graft are inside the bundle
An all-inclusive price and a facility price are not the same thing. Surgery Center of Allentown states explicitly that implants and cellular-based therapies are priced separately from its $11,091.70 and must be paid up front, with a refund for any implants not used. Surgery Center of Oklahoma includes the graft but excludes outside diagnostics, physical therapy, overnight stays, and treatment of complications. Newport’s rate includes implants and intraoperative radiology. Read the exclusions carefully, because on an ACL the fixation hardware and the graft are not small line items.
What else is torn in the knee
ACL tears travel with company. Newport prices an ACL reconstruction with a meniscal repair at $13,915 against $12,180 for the ACL alone, so roughly $1,735 for the added work. If your MRI shows a meniscus tear alongside the ACL, price both together rather than assuming the ACL quote covers it. Our meniscus surgery cost guide breaks that piece out separately.
Everything that happens before and after the operating room
The surgery is one of four line items in a real ACL episode. Newport Orthopedic Institute posts $900 for a self-pay MRI without contrast, $355 for an initial knee evaluation, and $165 for a follow-up visit. MDsave prices a single physical therapy session at $42 to $179 nationally, with a $118 MDsave average, and ACL rehab is measured in months of visits rather than a handful. Our guides to MRI cost without insurance and physical therapy cost without insurance cover how to shop those two separately, which is frequently where the easiest savings sit.
Cash Price vs. Insurance
ACL reconstruction is one of the clearest cases where a cash price can beat an insured price. If you carry a $7,000 or $9,000 deductible, a $7,931 bundled surgery center price is simply less than what a hospital will collect from you on the way through that deductible, and it arrives with no coinsurance, no separate anesthesia bill, and no surprise implant charge four weeks later.
The trade-off is that money paid as cash normally does not count toward your deductible or out-of-pocket maximum. That matters if you expect other large claims in the same plan year. Some practices, ATX Orthopedics among them, will break out the surgeon fee so you can submit for out-of-network reimbursement yourself.
If you are uninsured or choosing to self-pay, federal No Surprises Act rules entitle you to a written Good Faith Estimate before a scheduled procedure. Ask for it in writing and ask specifically whether the facility, the surgeon, the anesthesiologist, the surgical assistant, and the graft are all inside the number. Our guide to hospital price transparency explains how to pull a hospital’s own posted cash rate for CPT 29888 before you ever pick up the phone.
How to Pay Less
Ask which facility your case is scheduled at, then ask whether the other one is an option. The 2026 Medicare data shows the facility fee going from $4,817 to $7,413 between an ASC and a hospital outpatient department for identical work. Many orthopedic surgeons operate at both, and moving the case is often a scheduling question rather than a clinical one.
Collect bundled quotes from at least three surgery centers. The published prices in this guide came from Oklahoma, Pennsylvania, California, and Texas and landed between $7,931 and $15,500. That tells you a fair bundled ACL price is roughly $8,000 to $15,000 depending on market, and anything materially above it deserves a challenge. Run any quote through our fair price checker before you agree to it.
Price the MRI separately and up front. A standalone imaging center MRI is frequently a fraction of a hospital MRI, and your surgeon does not care where the scan was done as long as the images are readable. Newport publishes $900 for an MRI without contrast on its self-pay menu, which is a useful ceiling to shop against.
Budget rehab as its own line, then shop it. ACL recovery runs six to twelve months and physical therapy is the largest recurring cost in that window. At $42 to $179 per visit, the difference between a well-priced clinic and a hospital-owned one over dozens of sessions can exceed the savings on the surgery itself.
Ask for the self-pay discount before surgery, not after. Hospitals almost always have a posted uninsured discount that is applied on request rather than automatically. If a bill has already landed, our medical bill negotiation guide and the negotiation script tool give you the exact language, and requesting an itemized hospital bill first is what makes the negotiation possible at all.
Check charity care before assuming you do not qualify. Nonprofit hospitals are required to maintain financial assistance policies, and income thresholds are often well above the federal poverty line. Our hospital charity care guide and the charity care checker show how to find and apply to a specific hospital’s program. If a bill has already gone past due, our guide to medical bills in collections covers what happens next.
The Bottom Line
Budget $7,931 to $15,500 for a bundled arthroscopic ACL reconstruction at an ambulatory surgery center as of September 2026, with most published self-pay lists clustering between $11,000 and $13,500. Add roughly $900 for the MRI, $355 for the initial evaluation, and several months of physical therapy at $42 to $179 a visit, and a realistic full episode runs a few thousand dollars past the surgical quote.
The number that should drive your decisions is the facility gap. Medicare’s own 2026 figures put the facility fee for CPT 29888 at $4,817 in a surgery center and $7,413 in a hospital outpatient department, with an identical $889 surgeon fee on both sides. If you are paying out of pocket, where the operation happens is worth more to your wallet than anything else you can control. The same rule governs the other big orthopedic operations, which is why our knee replacement and rotator cuff surgery guides open the same way.