This is the third exhibit in the Line Items series. It annotates a total knee replacement bill, one of the most common elective orthopedic procedures in the United States, with roughly 790,000 performed annually. For a self-pay patient, the total can range from $17,000 at a transparent-pricing ambulatory surgery center to $65,000 or more at a hospital outpatient department.
The bill, annotated
The table below represents a composite inpatient total knee replacement at a mid-size metro hospital. Figures are based on publicly reported chargemaster data, Surgery Center of Oklahoma published pricing, and the CMS Hospital Price Transparency MRF patterns. This is not a quote from a specific facility.
Total Knee Replacement - Single Joint, Inpatient, 2-Night Stay
| Line Item | Chargemaster | Cash-Pay Range | Note |
|---|---|---|---|
| Operating room time (2.5 hrs) | $12,400 | $3,200 - $5,500 | SCO bundles this into one fee |
| Surgeon professional fee | $6,800 | $3,000 - $5,000 | Separate bill from surgeon's practice |
| Anesthesia (general, 2.5 hrs) | $4,200 | $1,500 - $2,800 | Often a third separate bill |
| Knee implant (cemented) | $14,500 | $4,000 - $8,000 | Hospitals mark up 200-400% |
| Recovery room | $3,600 | $800 - $1,500 | PACU time, usually 1-3 hrs |
| Room and board (2 nights) | $8,200 | $2,400 - $4,800 | Semi-private standard |
| Physical therapy (inpatient, 3 sessions) | $1,800 | $450 - $900 | Day-of and day-after mobilization |
| Pre-op labs and imaging | $2,100 | $350 - $800 | CBC, metabolic panel, EKG, X-ray |
| Pharmacy (inpatient meds) | $1,900 | $300 - $700 | Pain meds, antibiotics, blood thinners |
| Surgical supplies | $2,400 | $400 - $900 | Drapes, dressings, drains |
| Blood bank (standby + possible transfusion) | $1,200 | $200 - $600 | Type and screen, 2 units crossmatched |
| Total | $59,100 | $16,600 - $31,500 | SCO all-inclusive: $17,679 |
↑ The chargemaster total of $59,100 is what an uninsured patient would be billed by default if they did not ask for the self-pay rate. The actual cash-pay range of $16,600 to $31,500 represents a 47% to 72% reduction, simply by asking.
What this bill leaves out
Even an itemized hospital bill for a knee replacement typically excludes several costs that arrive as separate bills weeks or months later:
- Outpatient physical therapy: 12 to 24 sessions over 6 to 12 weeks at $100 to $200 per session cash. Total: $1,200 to $4,800.
- Post-op imaging: Follow-up X-rays at 6 weeks and 3 months, $100 to $300 each at an independent center.
- Durable medical equipment: Walker ($30 to $80), CPM machine rental ($200 to $400 per month if prescribed), knee brace ($50 to $200).
- Pathology: If tissue was sent for analysis, that bill comes from the pathology group, not the hospital.
- Home health aide: If discharge planning includes home visits, each visit is billed separately.
The implant markup
The single largest discretionary markup on a knee replacement bill is the implant. The hospital purchases a cemented knee system from a manufacturer for roughly $2,000 to $4,000. The chargemaster price for the same implant is $14,500 in this example. Even the cash-pay range of $4,000 to $8,000 represents a 100% to 200% markup over acquisition cost.
This is why Surgery Center of Oklahoma prices its total knee replacement at $17,679 all-inclusive: by selling implants at cost rather than marking them up, the total drops dramatically. Patients who are comparing quotes should always ask whether the implant is included in the facility fee and what the markup is.
Implant Cost: What the Hospital Pays vs What You Pay
Cemented total knee system. Manufacturer cost range based on industry reporting. Hospital markup varies widely.
How to use this exhibit
Print or save this annotated bill. When you receive a quote or a Good Faith Estimate for a knee replacement, compare it line by line against this exhibit. If a line item is missing from your estimate, ask where that cost will appear. If a line item is significantly above the cash-pay range shown here, ask why. The annotated notes in the right column are the questions the billing department does not expect you to ask.
Related on this site
Your right to an itemized bill explains how to request a line-by-line breakdown from any hospital.
Good Faith Estimate explained covers the pre-care estimate that should include these line items before surgery.
Elsewhere in the network
Knee replacement quote breakdown on surgeryquotes.com covers how a surgery quote for this procedure is structured and what to look for.
Range of Motion on jointreplacements.co covers joint replacement decision-making, recovery timelines, and implant comparisons.