What Surgery Actually Costs: Real Hospital Prices for 8 Common Operations (2026)

A knee replacement is billed at a median of $62,731 by U.S. hospitals. The amount those same hospitals actually collect for it — from Medicare and the patient combined — is a median of $12,623. The billed number is roughly five times the real one.

That gap is not a knee-replacement quirk. We ran Medicare's own hospital-level payment data across eight of the most common operations in America — the same federal dataset that powers the "Real Hospital Charges" table on our knee replacement and heart bypass cost pages. Across all eight, hospitals bill a median of about 5× (a range of 4.4× to 6.2×) what they actually accept as full payment. Here is the whole table, in one place.

Billed vs. collected: 8 common surgeries

"Billed" is the chargemaster gross charge — the sticker. "Collected" is the total allowed amount the hospital actually receives on a Medicare claim: Medicare's program payment plus the patient's deductible and coinsurance. Both figures are median values across every hospital in the data with enough volume to report, for federal fiscal year 2023 (the most recent Medicare data available).

Source: CMS Medicare inpatient (IPPS/DRG) and outpatient (OPPS/APC) provider data, FY2023. Each hospital's figures are volume-weighted across its reported claims; the table shows the median hospital for each operation. CMS Medicare Provider Utilization & Payment Data.

What "billed" and "collected" really mean

The billed charge is the hospital's chargemaster price — a master list of gross charges that almost nobody pays in full. It is the number that produces the eye-watering first line on an uninsured patient's statement. If that gap surprises you, our explainer on how the hospital chargemaster works walks through why the same surgery can be billed $3,000 at one hospital and $400,000 at another.

The "collected" column is the honest number: the total allowed amount, which is what Medicare's fee schedule sets as full payment for the procedure (Medicare's own share is even lower than this — the rest is the patient's deductible and 20% coinsurance). It is set by statute and the government's purchasing power, and it is remarkably consistent from hospital to hospital compared with the chaos of the billed column.

Is the markup a scandal? Not exactly

A 5× markup makes an easy headline, but the fair reading is more complicated. Hospitals argue — with real evidence — that Medicare pays below their cost for many services, and that they rely on higher commercial rates and high list prices to cover the shortfall, along with the cost of uninsured patients who never pay at all. Chargemaster charges also serve a mechanical purpose: they are the anchor for insurer negotiations and the basis for charity-care discounts. So the billed number is less a "real price" than an opening position. The useful takeaway is not "hospitals are gouging you" — it is "the first number you see is not the number that matters."

If you have insurance, the markup is mostly noise

For an insured patient, none of the numbers above is your bill. Your cost is governed by your plan: your deductible, your coinsurance, and your out-of-pocket maximum. Your insurer pays a negotiated rate the hospital already agreed to — and those commercial rates are high: private plans paid hospitals an average of 254% of Medicare in 2022, according to a 2024 RAND analysis of more than 4,000 hospitals. But you never touch that rate directly. What you actually owe for a covered operation is capped by your out-of-pocket max, no matter how big the billed charge looks. We break down that math in what you'll actually pay for surgery with insurance.

If you're uninsured or paying cash, the collected column is your reference

Here is where the data becomes a tool. If you are self-pay, do not anchor to the chargemaster sticker — and don't expect to pay the Medicare rate either, because you can't demand it. The realistic target sits in between: cash prices commonly land at a multiple of Medicare, well below the billed charge and typically below the ~254% commercial average. The collected column tells you where the floor is, so you know how much room exists to negotiate.

Two federal tools help you use it:

• Get a Good Faith Estimate in writing. Under the No Surprises Act, hospitals must give uninsured and self-pay patients a written estimate of expected charges before a scheduled surgery. If the final bill comes in $400 or more above the estimate, you can challenge it through the federal Patient-Provider Dispute Resolution process. (CMS, No Surprises Act.)
• Look up the hospital's posted cash price. Federal price-transparency rules require hospitals to publish a discounted cash price and their payer-specific negotiated rates. Since January 2025 they must also post an estimated allowed dollar amount when a charge is expressed as a formula. (45 CFR Part 180.) Our guide to looking up a hospital's price for your surgery shows where to find those files.

Once you have the estimate and the reference floor, the cash-pay negotiation playbook covers how to actually bring the number down.

The smaller the surgery, the bigger the markup

Read the markup column top to bottom and a counterintuitive pattern appears. The cheapest, most routine operations carry the highest multiples: cataract surgery is billed 5.6× what it collects, and hernia repair 6.2×. The largest, most complex operations carry the lowest: open-heart valve surgery is "only" 4.4×, heart bypass 4.9×. The markup and the actual price move in opposite directions.

The reason is structural. High-volume outpatient procedures — cataracts, hernias, arthroscopic work — are where hospitals have the most room to inflate list prices, because the underlying cost is low and the chargemaster can be marked up almost arbitrarily. On a $285,000 open-heart case, the billed number is already enormous, so the multiple over the collected amount is smaller even though the dollar gap is far larger. For a patient, the practical lesson is that the smallest surgeries often have the most negotiating air baked into the sticker — the very bills people are most tempted to just pay without questioning.

A worked example: the hernia bill

Suppose you're uninsured and facing a hernia repair. The chargemaster sticker is a median of $36,658. The collected reference — what a hospital accepts as full payment from Medicare and the patient combined — is $5,904. You can't demand that $5,904, but you now know the sticker is roughly six times the floor. A realistic self-pay target is a multiple of the Medicare-anchored amount, not the chargemaster: even at twice the reference, roughly $12,000, you'd be paying a third of the billed number. Walk in with the hospital's own Good Faith Estimate, the posted cash price, and that reference figure, and the conversation starts from data instead of from the sticker. That is the entire value of knowing the collected column.

Four caveats before you quote these numbers

1. These are facility charges only. The hospital bill is not the whole surgery. The surgeon, anesthesiologist, and assistants bill separately as professional fees — often thousands more — and the facility fee and anesthesia charge can arrive as their own statements. Add them in when you budget.

2. This is hospital-price comparison, not a bill audit. Medicare pays by bundled codes — DRGs for inpatient stays, APCs for outpatient — not the itemized CPT lines on your statement. The table tells you what an operation costs at the hospital level; it does not tell you whether a specific line item on your bill is correct.

3. Prices vary enormously by state and hospital. These are national medians. The same operation can cost several times more in one metro than another. Every procedure hub on this site has a state-by-state view built from this same CMS data — start with the knee replacement price map to see the spread.

4. Cosmetic and dental surgery aren't here. Medicare doesn't cover them, so there is no federal payment benchmark. For elective cosmetic pricing, which is quoted as an all-in cash price, see our data on plastic surgery costs by state.

The one move that changes your bill

You cannot control the chargemaster, and you probably can't get the Medicare rate. But you can refuse to treat the sticker as the price. Before you owe anything on a scheduled operation, get the Good Faith Estimate in writing, pull the hospital's posted cash price, and compare both against the collected figure for your procedure above. The distance between the billed number and that reference is not what you owe — it's your negotiating room.