Hip and knee replacement are, in CMS’s own words, the most common surgeries Medicare beneficiaries receive. Hip replacement is also one of the procedures where self-pay patients get burned the hardest, because the same operation can generate a $17,000 bill or a $93,000 bill depending entirely on where it happens and what was agreed in advance.
The confusion is not accidental. When you call around, some people quote you a surgeon’s fee, some quote a facility fee, some quote a package that excludes the implant, and a hospital will quote you a charge that nobody actually pays. This guide separates those numbers using 2026 published cash prices and 2024 CMS data released in April 2026, so you can tell what a quote actually covers before you sign anything.
What Does a Hip Replacement Cost Without Insurance?
A real all-in cash bundle runs about $17,500 to $43,000 as of August 2026. Published surgery-center prices cluster much tighter than that, between roughly $17,600 and $21,400.
| Price you might be quoted | Low | Typical | High |
|---|---|---|---|
| Surgeon fee only, Medicare-allowed (CPT 27130) | n/a | $1,417 | n/a |
| Surgeon fee only, average billed charge | n/a | $9,086 | n/a |
| All-in cash bundle at an ambulatory surgery center | $17,579 | $18,550 | $21,424 |
| All-in cash bundle on the MDsave marketplace | $17,466 | $25,881 | $33,550 |
| Major joint replacement, average state cash price (Sidecar) | $17,755 | n/a | $23,722 |
| MDsave’s estimated national average, outpatient hip | n/a | $43,058 | n/a |
| Hospital billed charge, no major complications (DRG 470) | n/a | $93,184 | n/a |
| Hospital billed charge, hip fracture without MCC (DRG 522) | n/a | $102,323 | n/a |
| Hospital billed charge, with major complications (DRG 469) | n/a | $149,677 | n/a |
| What Medicare actually pays a hospital (DRG 470) | n/a | $17,364 | n/a |
The surgery-center figures come from three centers that publish their rates openly. Surgery Center of Oklahoma lists total hip replacement at $17,579. Cedar Orthopaedic Surgery Center in Utah lists $18,550 through its instant price quote tool. The Orthopaedic Surgery Center lists $21,424 on its self-pay price list.
The hospital figures come from the CMS Medicare Inpatient Hospitals dataset for the 2024 data year, published in April 2026. Across 64,419 national discharges under MS-DRG 470, the average submitted covered charge was $93,184 and the average total payment was $17,364, of which Medicare paid $14,322. Read those two numbers together: the hospital asked for roughly five times what it collected.
The Six Prices People Confuse
The surgeon fee. This is the orthopaedic surgeon’s professional charge and nothing else. In 2024 CMS data, 17,461 providers billed CPT 27130 in a facility setting, with an average submitted charge of $9,086 and an average Medicare-allowed amount of $1,417. A quote in the four figures is almost certainly the surgeon alone.
The facility fee. The operating room, nursing, recovery, and supplies. At a hospital this is the largest single line and the one the chargemaster inflates most. At an ambulatory surgery center it is far smaller, which is the entire reason the bundles below work.
Anesthesia. Usually billed separately by a different group, which is how patients end up with a surprise second envelope weeks later. Every bundle listed above folds it in.
The implant. The most common hidden variable. Surgery Center of Oklahoma states plainly that its price does not include the hip device, though it sells the device at cost rather than marking it up. The Orthopaedic Surgery Center prices its total knee line explicitly “without implant cost.” Cedar Orthopaedic includes implants and says it is the only surgery center in Utah that does. Two quotes $3,000 apart can be identical once you settle this question.
The all-in bundle. One number covering surgeon, facility, anesthesia, and routine follow-up, paid up front. This is what you want.
The 90-day episode. Medicare’s Comprehensive Care for Joint Replacement model defined a joint replacement episode as the procedure plus all related Part A and Part B care for 90 days after discharge, including physical therapy and rehab. No surgical quote covers that whole window unless it says so.
What Drives the Price
Hospital inpatient versus ambulatory surgery center
This is the biggest lever by far. CMS removed total hip arthroplasty from the inpatient-only list in calendar year 2020, which is why outpatient hip replacement in a surgery center is now a normal option for healthy patients rather than an experiment. The published ASC bundles above are roughly a fifth of the average hospital charge for the same DRG.
Whether it is elective or a fracture
A planned replacement and a hip fracture repair are priced in different worlds because one is shoppable and one is not. CMS 2024 data puts the average submitted charge at $102,323 for MS-DRG 522, hip replacement with a principal diagnosis of hip fracture and no major complications, against $93,184 for the elective DRG 470 group.
Complications
MS-DRG 469 covers the same operation with major complications or comorbidities. Its average submitted charge was $149,677 and its average total payment $29,663, versus $17,364 for the uncomplicated group. Cash bundles typically exclude the treatment of major complications, so read that exclusion carefully.
Geography
Sidecar Health’s cash-price data for major joint replacement ranges from an average of $17,755 in Iowa to $23,722 in Minnesota, a spread of about a third. Because these bundles are prepaid and portable, driving or flying to a cheaper market is a genuine option and several of these centers openly market to out-of-state patients.
What comes after
Post-op physical therapy, home health, durable medical equipment, and pre-op imaging all sit outside most surgical quotes. Cedar Orthopaedic Surgery Center says its price covers the physical therapy for the date of service, which is a start but not a course of rehab. Price your own aftercare with our physical therapy cost guide before you compare two bundles.
Cash Price vs. Insurance
For a hip replacement the cash-versus-insurance math is unusual, because the cash price can be genuinely lower than what an insured patient’s deductible would eat. A high-deductible plan holder facing a $7,000 deductible plus coinsurance on a hospital’s negotiated rate can easily pay more out of pocket than a self-pay patient who prepaid a $18,550 bundle at a surgery center.
That is why the centers listed above put a warning on their own price lists: the cash rate applies only if you are not filing an insurance claim. You cannot prepay the bundle and then submit it to your plan. It is one road or the other, and you have to pick before surgery.
If you do go through a hospital, the leverage is the gap between charge and payment. CMS requires every hospital to post a machine-readable file of its prices, including a discounted cash price for self-pay patients, and enforcement of updated 2026 requirements began April 1, 2026. Our guide to hospital price transparency explains how to actually open one of those files and find your DRG.
You also have a federal right to a written number. Under the No Surprises Act, providers must give people who are not using insurance a good faith estimate when care is scheduled at least three business days ahead or on request, and you may be able to dispute a final bill that lands at least $400 above it.
How to Pay Less
Get the good faith estimate in writing, itemized. Ask for surgeon, facility, anesthesia, and implant as separate lines even inside a bundle. That is the only way to compare a hospital quote against a surgery center quote. Run the total through our fair price checker, and if the bill later exceeds the estimate, our itemized hospital bill guide covers the line-by-line audit.
Price an ambulatory surgery center bundle, including one out of state. The spread between a published $18,550 bundle and a hospital’s $93,184 charge is large enough that airfare is noise. Ask each center what happens if you need an overnight stay, and what its complication policy is.
Apply for charity care before the surgery, not after. Nonprofit hospitals must maintain a written financial assistance policy, and a medically necessary joint replacement generally qualifies. Screening yourself first takes minutes with our charity care checker, and our hospital charity care guide covers income thresholds and the documents to gather.
Negotiate against the payment, not the charge. If you are already holding a hospital bill, the number to anchor on is not the $93,184 charge, it is the roughly $17,364 that CMS reports hospitals actually receive for this stay. Our negotiation script and how to negotiate medical bills give you the exact language, including the prompt-pay discount ask.
Exhaust the cheaper steps first if your surgeon says there is room. Cost is not a medical reason to delay surgery, and this is a conversation for your doctor. But if conservative treatment is already on the table, know what those options cost: see our guides to cortisone shots, PRP injections, and physical therapy.
Budget the 90 days, not the surgery day. Ask each quote how many physical therapy visits, home health days, and follow-up appointments are inside the price, then price the rest yourself. A cheaper bundle that stops at the operating room door can easily end up costing more than a pricier one that carries you through rehab.
The Bottom Line
Budget $17,500 to $43,000 for a hip replacement paid in cash as of August 2026, and treat anything under $10,000 as a surgeon’s fee rather than a total. The published surgery-center bundles at $17,579, $18,550, and $21,424 are the realistic floor, and the difference between them is mostly the implant.
If your hip replacement is happening at a hospital, the sticker is not the price. A $93,184 average charge against a $17,364 average payment is not a rounding error, it is the entire negotiating range. Ask for charity care first, the itemized bill second, and a prompt-pay discount third. If you are also weighing a knee, our knee replacement cost guide runs the same numbers for the other joint, and our meniscus surgery guide covers the smaller knee operations.