Why does this not just tell me the price?

Because the number you pay has almost nothing to do with a national average. It is your allowed amount minus your remaining deductible, times your coinsurance, capped by your out-of-pocket maximum, plus physical therapy under its own rules. Every one of those is specific to you and knowable in an afternoon.

What if I do not know my allowed amount?

Leave it blank and estimate the physical therapy side alone, which is the part people underestimate anyway. Then call your plan with the CPT codes from the surgeon's office and come back.

Does hitting my out-of-pocket maximum mean everything is free?

Covered in-network care for the rest of that plan year, yes. Out-of-network care you chose, non-covered services, and visits beyond a hard visit cap generally do not count toward the maximum and are not covered past it.

Should I schedule surgery before or after my plan year resets?

Run it both ways in the calculator. If you have already met most of your deductible this year, operating before the reset can be substantially cheaper. If your recovery will span the reset either way, you may face two deductibles, and knowing that in advance beats finding out in February.

Updated August 17, 2026

Tool

ACL surgery out-of-pocket estimator

Your deductible, your coinsurance, your out-of-pocket maximum, your visit cap. No national averages, because the averages in circulation are unsourced and none of them are your plan.

Out-of-pocket estimator

This runs your plan's own numbers in the order your plan applies them: deductible first, then coinsurance, then the out-of-pocket maximum as a ceiling. Nothing is invented. Leave a box empty and that piece is simply left out of the total.

The surgery

Plan allowed amount, all providers

Not the billed charge. Ask your plan for the allowed amount at that facility, or add up the estimates for surgeon, facility and anesthesia.

Deductible you have left

What is left today, not the annual figure.

Coinsurance, in percent

Your share after the deductible. Defaults to 20% if left empty.

Out-of-pocket maximum

Your plan's in-network maximum for the plan year.

Already paid toward the out-of-pocket maximum this plan year

The physical therapy

Visits you expect to use

Visits your plan authorizes per year

Copay per visit, if your plan uses one

If you have a copay, it replaces deductible and coinsurance for those visits.

Allowed amount per visit, if no copay

Where to get each number

Allowed amount: Your plan's member cost estimator is the fastest route, and it uses your real accumulators. Failing that, ask the surgeon's office for the CPT codes and ask your plan what it allows for those codes at that facility. Hospitals must also publish a machine-readable file of standard charges including payer-specific negotiated rates, and an ACL reconstruction is one of the shoppable services they must display.
Deductible remaining: Your plan portal shows accumulated amounts. Use what is left today, and check when the plan year resets.
Coinsurance: Your summary of benefits and coverage, under inpatient or outpatient surgery. Commonly 10 to 30% in network.
Out-of-pocket maximum: Also in the summary of benefits. For 2026 the maximum annual limitation on cost sharing for non-grandfathered plans is $10,600 for self-only coverage and $21,200 for other than self-only coverage; your plan's own limit may be lower and that lower number is the one that applies to you.
Visit cap: Call the number on your card and ask how many rehabilitation visits are authorized per plan year. This is the number nobody checks and the one that runs out in month five.
Allowed amount per visit: Your explanation of benefits from any previous physical therapy shows it, or ask the clinic what your plan allows.

Why the out-of-pocket maximum matters more than the price

The ceiling is the answer

An ACL reconstruction plus months of physical therapy will, for a lot of people with commercial insurance, reach the out-of-pocket maximum. Once it does, additional covered in-network care in that plan year costs nothing more. Which makes the plan-year reset date one of the most financially consequential details in the whole recovery, and one of the least discussed.

What this calculator will not do

Invent an average price for your surgery. It asks for your allowed amount because that is the only figure that determines what you pay.
Predict how many physical therapy visits you will need. It asks, because the honest answer depends on your knee and on your plan's cap.
Account for out-of-network providers you choose, which fall outside the surprise billing protections.
Give you a quote. Only your plan and your providers can do that, and asking them in writing before the date is the whole point of running this first.

Two protections worth knowing about

Since January 2022, out-of-network providers who treat you at an in-network facility generally cannot balance bill you above your in-network cost sharing for emergency care and for many non-emergency services, including anesthesia and assistant surgeons. That is the rule that closed the classic ACL surprise bill.

If you are uninsured or paying cash, providers must give you a written good faith estimate of expected charges before a scheduled service, and you can dispute a final bill that exceeds it by $400 or more.