How much does ACL surgery cost with insurance?

For most people with commercial insurance, the answer is bounded by their out-of-pocket maximum, because an ACL reconstruction plus months of physical therapy often reaches it. For 2026 the maximum annual limitation on cost sharing for non-grandfathered plans is $10,600 self-only and $21,200 for other than self-only coverage, and many plans set a lower limit. Your remaining deductible and your coinsurance decide how much of that you actually spend.

Will insurance cover ACL reconstruction?

It is standard covered care for a torn ACL, subject to prior authorization, medical necessity documentation, and your cost sharing. Denials happen, most often on documentation, and they are appealable. Get the authorization confirmed in writing before the date.

Does insurance cover the physical therapy too?

Generally yes, subject to your cost sharing, any visit cap and reauthorization. The cap is the practical constraint: many plans authorize fewer visits than a nine-month recovery uses, so the visits have to be placed deliberately.

What if I get a surprise bill from the anesthesiologist?

Since January 2022, out-of-network providers treating you at an in-network facility generally cannot balance bill you above your in-network cost sharing for many non-emergency services including anesthesia and assistant surgeons. If a bill like that arrives, it is worth challenging rather than paying.

Can I negotiate or pay cash?

If you are uninsured or self-paying you are entitled to a written Good Faith Estimate before a scheduled service, and you can dispute a final bill that exceeds it by $400 or more. Bundled cash prices for ACL reconstruction exist and are sometimes lower than an insured patient's cost sharing, which is worth checking if you have a high deductible.

Updated August 17, 2026

Cost and insurance

What ACL surgery costs in the United States

Not a made-up national average. The mechanism: how your deductible, coinsurance, out-of-pocket maximum, visit cap and network status combine into the number you actually pay, and where to find your own figures.

Every page that tells you an ACL reconstruction costs a specific dollar amount is guessing, and the guess is useless to you anyway. What you pay is not the price. It is a function of your plan's allowed amount, your remaining deductible, your coinsurance percentage, your out-of-pocket maximum, whether every provider involved is in network, and how many physical therapy visits your plan authorizes.

That function is knowable. Here is how to fill it in with your own numbers instead of someone else's average.

The five numbers that decide everything

Allowed amount: What your plan has negotiated with that provider for that service. Not the billed charge, which is close to fiction for in-network care. This is the base your cost sharing is calculated on.
Deductible: What you pay before coinsurance starts. What matters is your remaining deductible today, and when the plan year resets.
Coinsurance: Your percentage after the deductible, commonly 10 to 30% in network. Some plans use flat copays for some services instead.
Out-of-pocket maximum: The ceiling. Once you reach it, covered in-network care is paid at 100% for the rest of the plan year. For 2026 the maximum annual limitation on cost sharing for non-grandfathered plans is $10,600 self-only and $21,200 for other than self-only coverage; your plan's own limit may be lower.
Visit cap: The number of rehabilitation visits your plan authorizes per plan year. This is the number most people never check, and it is the one that runs out in month five.

The reason a big surgery can be cheaper than it looks

An ACL reconstruction plus nine months of physical therapy will, for many people with commercial insurance, hit the out-of-pocket maximum. Once that happens the marginal cost of additional in-network care in that plan year is zero. Which makes the timing of the plan-year reset one of the most financially consequential details in your entire recovery.

What is billed, and by whom

An ACL reconstruction is not one bill. Expect separate claims from the surgeon, the facility (hospital outpatient department or ambulatory surgery center), the anesthesiologist, pathology or imaging if used, the graft if an allograft, durable medical equipment such as a brace or a cryotherapy unit, and then the physical therapy clinic, visit by visit, for months. In 2006, 95% of the 129,836 ACL reconstructions performed in the United States were outpatient, and the facility component still tends to be the largest single line.

Where to find your actual prices

Your plan's cost estimator

Most insurers publish a member cost estimator tool that uses your real accumulators. It is the single best starting point and almost nobody uses it.

The hospital's price file

Hospitals must publish a machine-readable file of standard charges including payer-specific negotiated rates, plus a consumer-friendly display of shoppable services. An ACL reconstruction is a shoppable service.

Ask the surgeon's office for the CPT codes

With the procedure codes in hand, your plan can quote the allowed amount for those specific codes at that specific facility.

A Good Faith Estimate if you are uninsured or paying cash

Providers must give you a written estimate of expected charges before a scheduled service, and you can dispute a final bill that exceeds it by $400 or more.

Ambulatory surgery center versus hospital outpatient

The same operation at an ASC often carries a lower facility component. Ask whether your surgeon operates at both and what your plan's allowed amounts are at each.

Network is where the surprises used to live

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 closed the classic ACL surprise bill, the out-of-network anesthesiologist. It does not cover everything: an out-of-network surgeon or an out-of-network facility you chose is still your cost, and physical therapy at an out-of-network clinic is still your cost.

Physical therapy is the part people underestimate

The surgery is one week. The physical therapy is nine months. Twenty visits with a $50 copay is $1,000, and twenty visits is less than many ACL recoveries need. Ask three questions before your first visit: how many visits are authorized, when the plan year resets, and whether reauthorization requires documented progress. The physical therapy page covers how to spend a limited number of visits where they change the outcome.

If you are on Medicare, the hard cap is gone but the KX modifier threshold for physical therapy and speech-language pathology combined is $2,480 for 2026, past which claims must carry the KX modifier and the record must justify continued care, with a targeted medical review threshold at $3,000.

Things worth doing before the operation

Confirm in writing that the surgeon, the facility and the anesthesia group are all in network.
Get the prior authorization number and what it covers.
Check your remaining deductible and your accumulated out-of-pocket total today.
Ask whether a brace and a cryotherapy unit are covered, and by whom. Durable medical equipment is a common surprise line.
If you have an HSA or FSA, plan the contribution around the plan year you will actually spend in.
If the surgery could reasonably fall on either side of a plan-year boundary, do the arithmetic both ways before you pick a date.
Keep every explanation of benefits. Billing errors on multi-provider episodes are common and they are only findable if you keep the paper.

Why there is no average price on this page

The figures in circulation come from commercial aggregators with no published methodology, and they vary by a factor of five between sources. Your plan's allowed amount at your facility is knowable in an afternoon and is the only number that affects you. The out-of-pocket estimator runs your numbers through the standard order of operations.