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Knee Replacement Cost in Delaware (2026): Average Prices & What You'll Pay

What does a knee replacement cost in Delaware?

For a commercially insured patient, a knee replacement in Delaware typically runs $3,194–$12,055 once facility and physician fees are combined. The median reported facility price across 4 hospitals is $2,904. The figures draw on CMS fee schedules and hospital price transparency data published under federal law.

ChristianaCare (formerly Christiana Care) is essentially a monopoly in northern Delaware and effectively the dominant system statewide. Low facility count means cash price variation is minimal, but commercial reimbursement rates are among the highest in the Mid-Atlantic region. Patients near the Pennsylvania or Maryland border often find meaningfully lower prices by crossing state lines.

Knee replacement is a high-cost elective procedure where facility selection has an outsized impact on total cost. Hospital outpatient and ambulatory surgery center rates for knee replacement have converged on outcomes but diverged further on price — ASC rates are typically 30–50% below hospital rates for the same implant and surgeon. Medicare Advantage plans increasingly direct patients to designated bundled-payment facilities where your out-of-pocket liability is capped.

Delaware prices for a knee replacement span 28.2× across 4 reporting hospitals, from $774 (PAM Squared at Dover LLC in Dover) up to $21,848 (Beebe Medical Center Inc. in Lewes) for identical care. Half of Delaware facilities price it at or below $2,904, with most clustered between $774 and $5,603. Insurers negotiate this down to a median of $774, while self-pay patients are quoted $7,873 — about 10.2× higher, so asking for the cash or insurer-negotiated rate is often the single biggest lever on your bill.

Forecast your out-of-pocket cost

How prices are distributed across Delaware hospitals:
  • Lower-cost hospitals (bottom 25%): under $774
  • Median hospital: $2,904
  • Higher-cost hospitals (top 30%): $5,603+

That's a 7× spread for the same procedure — driven entirely by which facility you choose, not by clinical complexity.

Example — two commercially insured patients in the same area:
  • Patient A (higher-rate plan or out-of-network): ~$5,603
  • Patient B (lower-rate in-network plan): ~$774
Same procedure. Same week. $4,829 difference.

Where knee replacement costs vary in Delaware

Pins show hospitals with price-transparency data (colored by vs. state average) and nearby ambulatory surgery centers, imaging centers, and other facilities (colored by type). Click any pin for facility name and estimated cost range.

Hospital (below avg) Hospital (above avg) Click a pin for details.

Estimate YOUR exact out-of-pocket cost →

Cheapest Knee Replacement Providers in Delaware

Based on declared cash/self-pay prices from CMS hospital price transparency files.

# Facility City Price vs Median
1 PAM Squared at Dover LLC Dover, DE $774 -$2,130
2 PAM Rehabilitation Hospital of Georgetown LLC DE $774 -$2,130
3 Christianacare Newark, DE $5,035 +$2,131
4 Beebe Medical Center Inc. Lewes, DE $10,711 +$7,807

Prices are declared self-pay rates. Contact each facility for a formal quote before scheduling.

The facility you choose matters more than almost anything else — the same procedure, same quality, same state can cost 5× more at one hospital versus the one down the road.

→ Compare all procedure costs   → Knee Replacement costs nationwide

Check YOUR hospital's pricing → Estimate YOUR exact cost →

Worth knowing: Declared gross charges vary significantly across Delaware hospitals — the same procedure can look very different on a hospital's price list versus what you actually owe. Cash and negotiated prices are a more practical guide.
Every hospital in this dataset offers a cash price — with a median of $7,873. If your deductible hasn't been met, always ask for the self-pay rate before scheduling.

What you'll actually pay — example scenarios

Your situation Estimated out-of-pocket
Deductible not yet met (pay in full) ~$6,936
Deductible met — 20% coinsurance ~$1,387
Out-of-network provider $15,259+

Based on a typical episode cost of $6,936 (facility + physician fees). Your actual cost depends on your plan deductible, coinsurance rate, and network tier. Get YOUR personalized estimate →

What this means for you

If you haven't met your deductible, you are effectively a cash-pay patient.

That means:

  • You should verify your hospital is in-network before an elective visit when possible
  • The cheapest facility can save you $2,130+ vs. the median.

This is the single biggest lever most patients have to reduce their cost.

Lower-cost options in Delaware start around $774 or below. Most hospitals cluster between $774 and $6,454. A smaller group reports prices above that — often academic medical centers or high-cost markets.

If you're comparing specific hospitals, the lowest self-pay rates reported in this dataset include: Christianacare in Newark (cash price from $5,035); Beebe Medical Center Inc. in Lewes (cash price from $10,711). These are declared cash prices — contact each facility for a formal quote before scheduling.

How where you go changes what you pay for knee replacement

The same knee replacement bundles different services depending on the setting — facility fee, surgeon fee, and anesthesia each arrive as separate bills. Estimated ranges below reflect the typical full bundled cost, including all expected charges.

Hospital Outpatient
$1,979–$17,651
  • Facility fee $774–$10,711
  • Professional fee $1,205–$6,940

Estimated from CMS fee schedules + commercial rate multipliers

Hospital Inpatient
$6,240–$11,975
  • Facility fee $5,035–$5,035
  • Professional fee $1,205–$6,940

Estimated from CMS fee schedules + commercial rate multipliers

Quick decision guide:
  • Best value hospitals (lowest prices): PAM Squared at Dover LLC: $774; PAM Rehabilitation Hospital of Georgetown LLC: $774; Christianacare: $5,035
  • Most expensive (outpatient): Beebe Medical Center Inc.: ~$10,711; Christianacare: ~$5,035

→ Choosing the right facility can save $2,130+ vs. the state median.

Delaware Knee Replacement prices by facility

All prices below come from hospital chargemasters — the official price lists each hospital must publish under federal law. Gross charge is the undiscounted list price; cash price is the self-pay rate; negotiated range covers the spread across insurance contracts.

How we calculate "Your Price" — We prioritize the most actionable price in this order:
  1. Cash price — the self-pay rate you can actually negotiate and pay
  2. Negotiated rate — if reported by the hospital across insurance contracts
  3. Gross charge — fallback only; this is the inflated list price few people pay

This reflects the real prices patients encounter — not inflated chargemaster rates.

# Facility City Your Price vs Median Gross Charge
#1 PAM Squared at Dover LLC Dover, DE $774 -$2,130 $774–$1,681
#2 PAM Rehabilitation Hospital of Georgetown LLC DE $774 -$2,130 $774–$1,681
#3 Christianacare Newark, DE $5,035 +$2,131 $5,035
#4 Beebe Medical Center Inc. Lewes, DE $10,711 +$7,807 $12,602–$21,848

Source: CMS hospital price transparency machine-readable files. vs Median = savings or premium relative to the state median price. Gross Charge = undiscounted list price for reference.

Received a bill? Check it for errors → Estimate YOUR cost before you go →

Compare other procedures in Delaware:

Where you can save the most on knee replacement in Delaware

These facilities have the lowest declared prices relative to the state median — they represent the best opportunities to reduce your out-of-pocket cost for this procedure.

Facility City Your Price vs Median
PAM Squared at Dover LLC Dover, DE $774 -$2,130
PAM Rehabilitation Hospital of Georgetown LLC DE $774 -$2,130
Christianacare Newark, DE $5,035 +$2,131
Beebe Medical Center Inc. Lewes, DE $10,711 +$7,807

How to choose a lower-cost facility

  • Choose independent outpatient centers when possible — freestanding ASCs (ambulatory surgical centers) consistently charge less than hospital outpatient departments for identical procedures.
  • Ask for the cash price if your deductible isn't met — self-pay rates are often lower than what insurance pays before your deductible is satisfied, especially at facilities that have a high cash-price discount.
  • Avoid hospital outpatient departments for routine cases — hospital-owned locations add a facility fee that freestanding centers don't charge, often adding $500–$1,500 to the same procedure.
Important: Many procedures are done at ambulatory surgical centers (ASCs) that are often 30–60% cheaper than hospital outpatient departments with the same clinical quality. Most ASCs are not in this hospital dataset — meaning your cheapest option may not even appear here. Ask your doctor if the procedure can be done at a freestanding ASC.

Most expensive knee replacement providers in Delaware

These facilities report the highest prices for this procedure. Academic medical centers and specialty hospitals often top this list — their gross charges rarely reflect what anyone actually pays, but understanding the spread helps you negotiate.

Facility City Price vs Median
Beebe Medical Center Inc. Lewes, DE $10,711 +$7,807
Christianacare Newark, DE $5,035 +$2,131
PAM Squared at Dover LLC Dover, DE $774 -$2,130
PAM Rehabilitation Hospital of Georgetown LLC DE $774 -$2,130

Why prices vary this much

Setting drives much of the gap in Delaware: the median outpatient price is $2,904 versus $5,035 inpatient — about 1.7× more, so where a procedure is performed often matters more than which hospital you choose. Of the Delaware facilities reporting prices, 2 fall in a low-cost tier (up to $774) while 1 sit in a high-cost tier ($6,454 and up) — a lower-priced option almost always exists within the same state.

The spread comes from how each hospital sets its chargemaster (the undiscounted list price), what cash discounts it applies, and what rates it negotiates with each insurer. Facility classification matters too — a hospital-owned outpatient center adds a facility fee that a freestanding clinic does not. Understanding these mechanics is the first step to paying less.

Learn more:
→ Allowed amount vs negotiated rate — what your EOB is really saying
→ How to read your medical bill
→ Why hospital prices are so hard to find — and what to do about it

How insurance changes what you actually pay

Hospital list prices are only part of the picture. What you pay out of pocket depends on your deductible, your plan's out-of-pocket maximum, whether the facility is in-network, and whether your plan classifies the visit as outpatient or inpatient. A lower gross charge doesn't guarantee a lower bill if the facility is out-of-network or adds facility fees your plan doesn't cover.

Understand your cost before you go:
→ Deductible vs out-of-pocket max
→ EOB vs medical bill — complete guide
→ How to stop medical bill problems before they start (in-network vs out-of-network)

Compare knee replacement costs in nearby states

Frequently asked questions: knee replacement costs in Delaware

How much does a knee replacement cost in Delaware?

Across 4 Delaware hospitals that publish prices, a knee replacement ranges from $774 to $21,848, with a median of $2,904. Most facilities fall between $774 and $5,603. What you pay depends on the facility, your insurance, and whether you have met your deductible.

Where is the cheapest place to get a knee replacement in Delaware?

Based on declared prices, the lowest-cost facility in our Delaware data is PAM Squared at Dover LLC in Dover at about $774. Freestanding ambulatory surgery and imaging centers are often cheaper still and may not appear in hospital price data — ask your doctor whether one is an option.

Why is a knee replacement so much cheaper at some Delaware hospitals?

Prices vary up to 28.2× because each hospital sets its own list price, cash discount, and insurer-negotiated rates. In Delaware, the median cash (self-pay) price is $7,873 versus a median negotiated rate of $774 — about 10.2× higher. Asking for the cash price or your insurer's negotiated rate is often the single biggest lever on what you pay.

How much will I actually pay out of pocket for a knee replacement in Delaware?

Your out-of-pocket cost depends on your deductible, coinsurance, out-of-pocket maximum, and whether the facility is in-network — not just the sticker price. If you have not met your deductible, you will typically pay the negotiated rate in full until you do. Use the CostKits cost forecaster to estimate your specific out-of-pocket amount before you go.

Explore all knee replacement cost data

→ See knee replacement costs across all states

Other Delaware Hospitals and ambulatory surgery centers for Knee Replacement

These hospitals and ambulatory surgery centers are registered in the CMS National Provider Identifier (NPI) registry as active hospitals and ambulatory surgery centers in Delaware. Cost estimates use the bundled service model for each place of service. Contact them directly for a formal quote.

Provider City Type Est. Cost
ADVANCE ENDOSCOPY CENTER LLC
3026780725 		DOVER, DE Ambulatory Surgical Center —
AMERICAN MOBILE HEALTHCARE
3026453235 		LEWES, DE General Acute Care Hospital $1,979–$17,651 bundled est.
ATLANTIC WOMENS MEDICAL SRV
3027641900 		WILMINGTON, DE Ambulatory Surgical Center —
ATLANTIC WOMENS MEDICAL SRV OF DOVER
3026783383 		DOVER, DE Ambulatory Surgical Center —
BAYHEALTH
3027447135 		DOVER, DE General Acute Care Hospital $1,979–$17,651 bundled est.
BAYHEALTH MEDICAL CENTER, INC.
3026744700 		DOVER, DE General Acute Care Hospital $1,979–$17,651 bundled est.
BEEBE HEALTHCARE
3026453728 		LEWES, DE Women's Hospital $1,979–$17,651 bundled est.
BEEBE HEALTHCARE
3026453728 		LEWES, DE Women's Hospital $1,979–$17,651 bundled est.
BEEBE HEALTHCARE
3022491448 		GEORGETOWN, DE General Acute Care Hospital $1,979–$17,651 bundled est.
BEEBE HEALTHCARE
3026453300 		LEWES, DE Critical Access Hospital $1,979–$17,651 bundled est.
BEEBE HEALTHCARE
3026453300 		LEWES, DE General Acute Care Hospital $1,979–$17,651 bundled est.
BEEBE HEALTHCARE
3026453300 		LEWES, DE General Acute Care Hospital $1,979–$17,651 bundled est.
▼ Show 72 more Delaware hospitals and ambulatory surgery centers
BEEBE MEDICAL CENTER
3029472500 		LEWES, DE General Acute Care Hospital $1,979–$17,651 bundled est.
BEEBE MEDICAL CENTER, INC.
3026453300 		LEWES, DE General Acute Care Hospital $1,979–$17,651 bundled est.
C & S MEDICAL, LLC
3022250177 		NEWARK, DE Ambulatory Surgical Center —
CEDAR TREE SURGICAL LLC
3026984441 		CAMDEN, DE Ambulatory Surgical Center —
CENTER FOR SPINE SURGERY LLC
3029847178 		WILMINGTON, DE Ambulatory Surgical Center —
CENTRAL DELAWARE ENDOSCOPY UNIT LLC
3024223393 		DOVER, DE Ambulatory Surgical Center —
CENTRE FOR COSMETIC SURGERY & MEDICINE LLC
3029948492 		LEWES, DE Ambulatory Surgical Center —
CHARLENE JENKINS
3026453300 		LEWES, DE General Acute Care Hospital $1,979–$17,651 bundled est.
CHRISTIANA CARE
3029819931 		CLAYTON, DE General Acute Care Hospital $1,979–$17,651 bundled est.
CHRISTIANA CARE
3027331000 		NEWARK, DE General Acute Care Hospital $1,979–$17,651 bundled est.
CHRISTIANA CARE
9179214618 		NEW CASTLE, DE General Acute Care Hospital $1,979–$17,651 bundled est.
CHRISTIANA CARE HEALTH SERVICES
3027336339 		NEW CASTLE, DE General Acute Care Hospital $1,979–$17,651 bundled est.
CHRISTIANA CARE HEALTH SERVICES
3027332410 		NEWARK, DE General Acute Care Hospital $1,979–$17,651 bundled est.
CHRISTIANA CARE HEALTH SERVICES
3027332666 		NEWARK, DE General Acute Care Hospital $1,979–$17,651 bundled est.
CHRISTIANA CARE HEALTH SERVICES
3027335582 		NEWARK, DE General Acute Care Hospital $1,979–$17,651 bundled est.
CHRISTIANA CARE HEALTH SERVICES
3027334387 		NEWARK, DE General Acute Care Hospital $1,979–$17,651 bundled est.
CHRISTIANA CARE HEALTH SERVICES
3027331000 		NEWARK, DE Critical Access Hospital $1,979–$17,651 bundled est.
CHRISTIANA CARE HEALTH SERVICES INC
3027331000 		WILMINGTON, DE Ambulatory Surgical Center —
CHRISTIANA CARE HEALTH SERVICES, INC.
3027331000 		WILMINGTON, DE General Acute Care Hospital $1,979–$17,651 bundled est.
CHRISTIANA CARE HEALTH SYSTEM
3027331042 		NEWARK, DE Critical Access Hospital $1,979–$17,651 bundled est.
CHRISTIANA CARE HEALTH SYSTEM
3026232593 		NEWARK, DE General Acute Care Hospital $1,979–$17,651 bundled est.
CHRISTIANA CARE HEALTH SYSTEM
3027331000 		NEWARK, DE General Acute Care Hospital $1,979–$17,651 bundled est.
CHRISTIANA CARE HEALTH SYSTEM
2158887564 		NEWARK, DE General Acute Care Hospital $1,979–$17,651 bundled est.
CHRISTIANA CARE HEALTH SYSTEM
3027334176 		NEWARK, DE Critical Access Hospital $1,979–$17,651 bundled est.
CHRISTIANA CARE HOSPITAL
6104057662 		NEWARK, DE Critical Access Hospital $1,979–$17,651 bundled est.
CHRISTIANA HOSPITAL
2036452903 		NEW CASTLE, DE Critical Access Hospital $1,979–$17,651 bundled est.
CHRISTIANA SPINE AMBULATORY SURGICAL CENTER, LLC
3026027000 		NEWARK, DE Ambulatory Surgical Center —
CHRISTIANACAREHEALTHSERVICES
3027317449 		NEWARK, DE General Acute Care Hospital $1,979–$17,651 bundled est.
CLEARWAY SURGERY CENTER OF DOVER LLC
8555277246 		DOVER, DE Ambulatory Surgical Center —
COMMUNITY BIRTH GROUP
8003418598 		WILMINGTON, DE General Acute Care Hospital $1,979–$17,651 bundled est.
CTS SURGICAL ASSOCIATES LLC
3029459730 		MILLSBORO, DE Ambulatory Surgical Center —
DAI OK MOON MD PA
3027310600 		WIMINGTON, DE General Acute Care Hospital $1,979–$17,651 bundled est.
DELAWARE EYE SURGERY CENTER, LLC
3026452300 		REHOBOTH BEACH, DE Ambulatory Surgical Center —
DELAWARE INSTITUTE FOR REPRODUCTIVE MEDICINE
3027384600 		NEWARK, DE Ambulatory Surgical Center —
DELAWARE SURGERY CENTER, LLC
3023464000 		DOVER, DE Ambulatory Surgical Center —
DELMARVA INTEGRATED NETWORK
3026453300 		LEWES, DE General Acute Care Hospital $1,979–$17,651 bundled est.
DIRM SURGERY CENTER
3027384600 		NEWARK, DE Ambulatory Surgery Center —
DOVER OPHTHALMOLOGY ASC, LLC
3026784688 		DOVER, DE Ambulatory Surgical Center —
DOVER SURGICENTER, LLC
3022702798 		DOVER, DE Ambulatory Surgical Center —
EGNM LLC
3026443466 		LEWES, DE Ambulatory Surgical Center —
FIRST STATE SURGERY CENTER, LLC
3026830700 		NEWARK, DE Ambulatory Surgical Center —
FOULK ROAD SURGERY CENTER
3027774800 		WILMINGTON, DE Ambulatory Surgical Center —
GLASGOW MEDICAL CENTER LLC
3028363539 		NEWARK, DE Ambulatory Surgical Center —
INFINITY ASC LLC
6103600636 		WILMINGTON, DE Ambulatory Surgical Center —
JENIFER RUSSELL
3026453100 		LEWES, DE General Acute Care Hospital $1,979–$17,651 bundled est.
KIRKWOOD ENDOSCOPY CENTER LLC
3024539171 		NEWARK, DE Ambulatory Surgical Center —
LEWES DE ENDOSCOPY ASC LLC
3026443852 		LEWES, DE Ambulatory Surgical Center —
LIMESTONE MEDICAL CENTER, LLC
3029929831 		WILMINGTON, DE Ambulatory Surgical Center —
MID-ATLANTIC ENDOSCOPY CENTER, LLC
3029930310 		NEWARK, DE Ambulatory Surgical Center —
MINIMALLY INVASIVE SURGICAL AND NEUROSCIENCE LLC
3027380300 		NEWARK, DE Ambulatory Surgical Center —
NANTICOKE SURGICAL CENTER LLC
3025366094 		SEAFORD, DE Ambulatory Surgical Center —
NASPAC 1 PRO LLC
3024393063 		NEWARK, DE Ambulatory Surgical Center —
NEWARK ENDOSCOPY ASC LLC
3028922710 		NEWARK, DE Ambulatory Surgical Center —
OCEAN ENDOSCOPY CENTER LLC
3026449190 		REHOBOTH BEACH, DE Ambulatory Surgical Center —
ORTHOPAEDIC SPECIALISTS SURGI-CENTER, LLC
3023514848 		NEWARK, DE Ambulatory Surgical Center —
OUTPATIENT UROLOGY CENTER OF DOVER, LLC
3027368808 		DOVER, DE Ambulatory Surgical Center —
PENINSULA ENDOSCOPY CENTER
3022833300 		NEWARK, DE Ambulatory Surgical Center —
PENINSULA REGIONAL MEDICAL CENTER
4105437437 		MILLSBORO, DE General Acute Care Hospital $1,979–$17,651 bundled est.
ROCKLAND SURGERY CENTER, L.P.
3029990200 		WILMINGTON, DE Ambulatory Surgical Center —
SEAFORD SPECIALTY SURGERY CENTER LLC
3027347246 		SEAFORD, DE Ambulatory Surgical Center —
SELECT SPECIALTY HOSPITAL - WILMINGTON INC
3024214591 		WILMINGTON, DE General Acute Care Hospital $1,979–$17,651 bundled est.
ST FRANCIS HEALTHCARE, INC.
3024214100 		WILMINGTON, DE General Acute Care Hospital $1,979–$17,651 bundled est.
ST. FRANCIS HOSPITAL
3025758041 		WILMINGTON, DE General Acute Care Hospital $1,979–$17,651 bundled est.
ST. FRANCIS HOSPITAL
3025758041 		WILMINGTON, DE General Acute Care Hospital $1,979–$17,651 bundled est.
ST. FRANCIS HOSPITAL
3024214368 		WILMINGTON, DE General Acute Care Hospital $1,979–$17,651 bundled est.
ST. FRANCIS HOSPITAL INC.
3024214100 		WILMINGTON, DE General Acute Care Hospital $1,979–$17,651 bundled est.
ST.FRANCIS HOSPITAL
3025758041 		WILMINGTON, DE General Acute Care Hospital $1,979–$17,651 bundled est.
SURGERY CENTERS OF DELMARVA, LLC
3028384330 		NEWARK, DE Ambulatory Surgical Center —
UNION HOSPITAL OF CECIL COUNTY
4103984000 		MIDDLETOWN, DE General Acute Care Hospital $1,979–$17,651 bundled est.
WESTERN KENTUCKY AMBULATORY SURGERY CENTER LLC
3025422770 		LEWES, DE Ambulatory Surgical Center —
WILLS EYE SURGERY CENTER
3027774800 		WILMINGTON, DE Ambulatory Surgical Center —
WILMINGTON VAMC
7172776568 		WILMINGTON, DE General Acute Care Hospital $1,979–$17,651 bundled est.

Est. cost = bundled estimate (facility fee + professional fee + anesthesia where applicable) based on CMS fee schedules and commercial rate multipliers. Contact each provider for an actual quote.

Source: CMS NPPES NPI Registry. NPI numbers can be verified at npiregistry.cms.hhs.gov.

Where You Get a Knee Replacement Matters

Hospital outpatient departments typically charge 2–4× more than ASCs or independent centers for the same procedure — same outcome, very different bill.

Ambulatory Surgery Center

Ambulatory Surgery Center typically carries a mid-range price for a knee replacement. Typically 40–60% less than hospital OP for surgical procedures. Anesthesia billed separately. You can shop here — call ahead and ask for a self-pay or cash quote.

Hospital Inpatient

Hospital Inpatient typically carries the highest price for a knee replacement. DRG-based billing bundles most services. Professional fees billed separately. Length of stay drives cost.

What's Actually on Your Knee Replacement Bill

A knee replacement involves multiple providers — each bills separately. Understanding each line item helps you verify your Explanation of Benefits and catch billing errors.

Asc

  • ASC Facility Fee — Device-intensive (J8 payment indicator) — ASC payment = OPPS payment minus device offset. MRF data shows 30–70% less than hospital OP in some markets.
  • Orthopedic Surgeon Professional Fee
  • Anesthesia
  • Implant Device Cost

Hospital Inpatient

  • Drg Facility Stay — DRG 470 (major joint replacement without MCC) most common.
  • Orthopedic Surgeon Professional Fee
  • Anesthesia
  • Implant Device Cost

Knee Replacement Cost by Type

Which type your doctor orders changes the billing code — and what you pay. Here's how the common types differ.

Total Knee Replacement

A recognized variation that can change the billing code and what you owe. Most common. Replaces entire joint surface.

Partial Knee Replacement (Unicompartmental)

A recognized variation that can change the billing code and what you owe. Less invasive when only one compartment is damaged. Faster recovery.

Knee Revision Surgery

A recognized variation that can change the billing code and what you owe. Replacement of a failed implant. Significantly more complex and expensive.

This Procedure Is Shoppable — Choosing the Right Facility Can Save Thousands

Knee Replacement is elective and schedulable. You have time to compare facilities — and hospital outpatient prices often run 2–4× higher than ASC for identical clinical outcomes.

How to shop: Ask your doctor for the CPT code, then call 2–3 facilities and request an out-of-pocket cost estimate. Confirm your insurance is accepted. If uninsured, ask for the cash-pay rate — it's usually 20–50% below the list price.

Prior Authorization Is Usually Required

Most commercial and Medicare Advantage plans require pre-approval for knee replacement before scheduling. If your doctor submits the order without prior authorization — or if the authorization lapses — your insurer can deny the entire claim, leaving you responsible for the full cost.

Action step: Call the member services number on your insurance card before scheduling. Ask: "Does this procedure require prior authorization?" Get the authorization number in writing and confirm it's attached to the claim before your appointment.

The Implant Is the Largest Cost Driver

For knee replacement, the implant or device typically accounts for 40–70% of the total hospital bill. Surgeons have preferred device relationships that affect which implant is used — and different implants can vary by $5,000–$15,000 in cost.

What to ask: Request an itemized estimate that breaks out the implant separately. Ask your surgeon whether a comparable implant is available at a lower cost.

Who performs this: Knee Replacement is typically performed by a Orthopedic Surgery. The specialist's professional fee is billed separately from the facility charge — you will likely receive separate bills from each.

CostKits compiles hospital price transparency data to help families make informed decisions. If you've received a bill for this procedure:
→ Analyze your medical bill for errors
→ How to negotiate your medical bills
→ Track and manage your healthcare costs (free account)

Other Procedure Costs in Delaware

Interested in understanding healthcare costs and managing your medical expenses?

About the Author

John Caruso, FSA, MAAA

Healthcare actuary with 20+ years of experience in insurance pricing, medical billing systems, and healthcare cost analytics.

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Published May 15, 2026 · Updated May 15, 2026

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