ACL reconstruction combined with meniscus repair typically costs between $20,000 and $50,000 before insurance in the United States, though what you actually pay depends heavily on your insurance plan, where you have the surgery, and the specific procedures involved. If you have insurance and the surgery is approved as medically necessary, your out-of-pocket share is usually limited to your deductible and coinsurance, often landing between $1,000 and $5,000 for most plans.
Where the Money Goes
The total bill for knee surgery breaks down into a few predictable categories, and the facility fee is by far the largest. For a typical ACL reconstruction, facility charges account for roughly 68% of the total cost. The orthopedic surgeon’s fee makes up about 18%, and anesthesia covers another 8%. The remaining slice goes to supplies, imaging, and other miscellaneous charges.
When you add meniscus repair to an ACL reconstruction, the surgeon performs both procedures during the same operation, which keeps costs lower than having two separate surgeries. Still, the combined procedure adds surgical time, additional suture anchors or instruments, and a second billing code, so the total rises by several thousand dollars compared to ACL reconstruction alone.
Medicare’s 2026 national averages give a useful baseline for the meniscus portion alone. A surgical meniscectomy (partial removal of torn meniscus) costs about $2,159 total at an ambulatory surgery center, with the patient paying around $431 out of pocket. That same procedure at a hospital outpatient department jumps to $3,857, with the patient’s share rising to about $771. The surgeon’s fee stays the same ($515) in both settings. The entire difference comes from the facility fee, which doubles from $1,644 at a surgery center to $3,342 at a hospital.
Surgery Center vs. Hospital Pricing
Where you have your surgery can swing the bill by thousands of dollars. A study in the Canadian Journal of Surgery found that ACL reconstruction performed at an ambulatory surgery center saved an average of $1,684 per case compared to the same procedure done in a hospital outpatient department. Most ACL and meniscus surgeries are now performed on an outpatient basis, meaning you go home the same day, but some hospitals still charge facility fees that reflect their higher overhead.
If your surgeon operates at both a hospital and a freestanding surgery center, asking about the cost difference between the two locations is one of the simplest ways to reduce your bill. The surgical team, anesthesia approach, and recovery protocol are typically identical. The savings come purely from the lower facility overhead at a surgery center.
How Graft Choice Affects Cost
During ACL reconstruction, the surgeon replaces your torn ligament with a graft. The two main options are an autograft (tissue taken from your own body, usually the patellar tendon or hamstring) or an allograft (donor tissue from a tissue bank). Allografts cost significantly more. A University of Minnesota study found the average surgical cost was $4,147 for allograft cases versus $3,154 for autograft, a difference of nearly $1,000 driven almost entirely by the price of the donor tissue itself.
Supply costs made up about 72% of total expenses in allograft cases compared to 59% in autograft cases. Your surgeon will recommend a graft type based on your age, activity level, and the specifics of your tear, but it’s worth understanding that the choice has a real financial impact too.
Costs That Vary by State
Geography plays a surprisingly large role. Average ACL surgery costs range from about $6,269 in Iowa to $8,913 in Alaska. The five most expensive states for ACL knee surgery are Alaska, New Jersey, Minnesota, California, and Rhode Island, all averaging above $8,100. The least expensive states include Iowa, South Dakota, Kansas, North Carolina, and Arkansas, all below $6,550. These figures represent the surgeon and facility fees and don’t include physical therapy, bracing, or other post-surgical costs.
If you live near a state border, it may be worth checking whether your insurance network includes facilities in a neighboring, lower-cost state.
What Insurance Requires for Approval
Insurance companies classify ACL reconstruction and meniscus repair as medically necessary procedures, not elective, but they require documentation before they’ll authorize coverage. For ACL reconstruction, the typical requirements include an MRI confirming a complete tear, clinical signs of knee instability (your knee “giving way” or buckling), and no evidence of severe arthritis in the joint. If your tear is partial, most insurers want to see that you’ve tried at least 12 weeks of nonsurgical treatment without improvement before approving surgery. Competitive athletes or people with physically demanding jobs may qualify for faster approval.
For meniscus repair, insurers generally require at least three clinical signs (joint-line tenderness, catching or locking, pain with specific exam maneuvers) plus at least six weeks of failed conservative treatment. The MRI needs to confirm a tear pattern that’s actually repairable. If you have moderate to severe arthritis visible on X-rays, approval becomes more difficult because the evidence for surgical benefit in arthritic knees is weaker.
When both injuries are present together, the case for approval is often straightforward. An MRI showing an ACL tear alongside a repairable meniscus tear is itself considered a qualifying criterion for reconstruction at many insurers.
Hidden and Extra Costs
The surgical bill is only part of the total expense. Physical therapy after ACL and meniscus surgery typically runs six to nine months, with visits two to three times per week in the early stages. Even with insurance, copays of $30 to $75 per visit add up quickly over dozens of sessions. Some patients spend $1,500 to $3,000 on physical therapy copays alone over the course of recovery.
You’ll also need a hinged post-operative knee brace. Retail prices range from about $100 to $170 for a standard model, though hospitals and surgical centers sometimes charge $300 or more for the same brace dispensed on the day of surgery. Buying one yourself ahead of time (with your surgeon’s approval on the specific model) can save a surprising amount. A cold therapy unit for managing swelling at home runs $100 to $250 if your surgeon recommends one.
Other costs that catch people off guard include pre-surgical MRI copays (often $100 to $300), crutches ($25 to $50), and time away from work. Most people with desk jobs return in one to two weeks, but physically demanding jobs can require three to six months off, which represents a significant financial impact even if it doesn’t show up on a medical bill.
How to Estimate Your Actual Cost
Start by calling your insurance company and asking for a pre-authorization estimate that includes the specific procedure codes your surgeon’s office provides. For a combined ACL reconstruction and meniscus repair, the relevant codes are typically 29888 (ACL reconstruction) and 29882 or 29881 (meniscus repair or meniscectomy). Your insurer can tell you the allowed amount for each code at your specific facility, and from there you can calculate your share based on your deductible and coinsurance.
If you’re uninsured or paying cash, request a self-pay quote directly from the surgery center. Many facilities offer a bundled cash price that’s 40% to 60% below the amount they’d bill to insurance. Surgery centers in lower-cost states have advertised all-inclusive cash prices for ACL reconstruction in the $10,000 to $15,000 range, though adding meniscus repair increases that figure. Always confirm whether the quote includes the surgeon’s fee, anesthesia, facility fee, and implant costs, because some “bundled” prices leave one of those out.