Knee Replacement Cost in Raleigh, NC – 2025 Complete Guide
Facing a knee replacement can be overwhelming—especially when you’re unsure about the cost. The cost of knee replacement in Raleigh, NC can vary widely, and understanding your options is crucial to making informed decisions. This 2025 guide draws on trusted sources like the American Academy of Orthopaedic Surgeons, CMS.gov, and Fair Health to help you navigate the financial side of knee surgery with confidence. Whether you’re uninsured, exploring Medicare, or just planning ahead, this guide is tailored for patients in the Raleigh area.
What is the average cost of knee replacement in Raleigh, NC?
The average cost of knee replacement surgery in Raleigh, NC ranges from $30,000 to $55,000, depending on the facility, surgeon, and whether the procedure is inpatient or outpatient. According to Fair Health, the national average for a total knee replacement (CPT code 27447) is approximately $37,000, but local costs in Raleigh can be higher due to regional healthcare pricing and provider fees. CMS.gov data shows that Medicare reimbursement for inpatient knee replacement in North Carolina typically ranges from $12,000 to $18,000, depending on the hospital’s classification and patient complexity.
Private insurance patients may see higher charges due to negotiated rates, while uninsured patients may face full list prices unless financial assistance is available. Academic medical centers in Raleigh, such as UNC Rex Healthcare and Duke Raleigh Hospital, may offer bundled pricing or financial counseling for eligible patients.
What factors affect the cost of knee replacement?
Several factors influence the total cost of knee replacement surgery. According to the American Academy of Orthopaedic Surgeons (AAOS), key cost drivers include the type of procedure (total vs. partial knee replacement), surgeon fees, anesthesia, hospital stay duration, and post-operative rehabilitation. The setting of care also matters—outpatient procedures typically cost less than inpatient ones.
Geographic location plays a role, too. Raleigh’s healthcare market tends to have higher facility fees compared to rural areas. The Centers for Medicare & Medicaid Services (CMS) notes that hospital charges can vary based on whether the facility is a teaching hospital or part of a larger health system. Additionally, any complications or pre-existing conditions can increase costs due to extended recovery or additional care needs.
Finally, implant type and surgical technology (e.g., robotic-assisted surgery) may add to the total cost but could offer benefits in outcomes and recovery time.
Does insurance cover knee replacement?
Yes, most insurance plans, including Medicare and private insurers, cover medically necessary knee replacement surgery. According to CMS.gov, Medicare Part A typically covers inpatient hospital costs, while Part B covers outpatient services and physician fees. Patients are responsible for deductibles, coinsurance, and any services not deemed medically necessary.
Private insurance coverage varies by plan but generally includes knee replacement if conservative treatments have failed. The American Association of Hip and Knee Surgeons (AAHKS) advises patients to obtain pre-authorization and confirm network status of the surgeon and facility to avoid unexpected charges.
Medicaid coverage for knee replacement in North Carolina is more limited and may require prior approval. Patients should consult their insurance provider to understand their specific benefits, out-of-pocket costs, and network requirements.
Are there payment plans or financing options available in Raleigh?
Yes, many hospitals and orthopedic practices in Raleigh offer payment plans or financing options for knee replacement surgery. According to Healthcare Bluebook, patients without insurance or with high deductibles often qualify for structured payment plans through hospital billing departments. These plans may include interest-free options for a set period or extended financing through third-party services like CareCredit.
UNC Rex Healthcare and WakeMed, two major providers in Raleigh, offer financial assistance programs for eligible patients based on income and family size. These programs can significantly reduce or even eliminate out-of-pocket costs for qualifying individuals. It’s important to inquire early in the planning process, as applications may require documentation and approval before surgery is scheduled.
Some orthopedic practices also offer bundled pricing that includes the procedure, facility fees, and follow-up care, which can provide cost transparency and predictability.
How does the cost in Raleigh compare to other North Carolina cities?
Raleigh’s knee replacement costs are generally on par with other major cities in North Carolina but may be slightly higher than in rural or less densely populated areas. According to Fair Health, the average cost for a total knee replacement in Charlotte is similar, ranging from $32,000 to $52,000, while cities like Asheville or Fayetteville may offer slightly lower prices due to reduced facility and labor costs.
However, Raleigh’s medical infrastructure—featuring nationally recognized hospitals and specialized orthopedic centers—can justify the higher price point for some patients. The North Carolina Department of Health and Human Services notes that access to advanced surgical techniques and experienced surgeons may be more readily available in urban centers like Raleigh, which can impact both cost and outcomes.
Patients willing to travel may find cost savings in smaller cities, but should weigh those savings against the quality of care and convenience factors.
What’s included in the knee replacement cost?
The total cost of a knee replacement typically includes several components. According to the American Academy of Orthopaedic Surgeons (AAOS), these include pre-operative consultations, imaging (X-rays or MRIs), surgeon’s fees, anesthesia, hospital or surgical center charges, the implant itself, and post-operative physical therapy.
Some providers in Raleigh offer bundled pricing, which may also include follow-up visits, medication, and rehabilitation services. It’s important to clarify what’s included in a quote, as some costs—like durable medical equipment (e.g., walkers or braces) or extended rehab—may be billed separately.
Healthcare Bluebook recommends asking for a detailed cost breakdown to avoid surprise billing. Patients should also verify whether their insurance covers all components or if certain services, like outpatient physical therapy, are subject to separate deductibles or copays.
Do I need a partial or total knee replacement, and how much does it cost?
Whether you need a partial or total knee replacement depends on the severity and location of your joint damage. According to the American Association of Hip and Knee Surgeons (AAHKS), partial knee replacements are suitable for patients with damage confined to one compartment of the knee and often result in faster recovery.
Cost-wise, partial knee replacements are generally less expensive. Fair Health data shows that the average cost of a partial knee replacement (CPT code 27446) in Raleigh ranges from $20,000 to $35,000, compared to $30,000 to $55,000 for a total knee replacement. However, not all patients are candidates for the less invasive option.
Your orthopedic surgeon will use imaging and clinical evaluation to determine the best approach. While partial replacements may have lower upfront costs, they may not be as durable for patients with widespread arthritis or advanced joint degeneration.
How long does the knee replacement process take?
The full knee replacement process—from initial consultation to full recovery—can take several months. According to the American Academy of Orthopaedic Surgeons (AAOS), the surgical procedure itself typically lasts 1 to 2 hours. Most patients stay in the hospital for 1 to 3 days, though outpatient knee replacement is becoming more common in Raleigh for eligible candidates.
Pre-operative preparation may include several weeks of physical therapy, medical evaluations, and imaging. Post-operatively, patients generally require 6 to 12 weeks of rehabilitation, with full recovery taking up to 6 months depending on age, health status, and adherence to physical therapy.
Patients in Raleigh have access to comprehensive rehab programs through providers like WakeMed and UNC Rex, which can support faster and more complete recovery.
What is the success rate of knee replacement?
Knee replacement surgery is considered highly successful, with long-term outcomes improving significantly over the past two decades. According to the American Academy of Orthopaedic Surgeons (AAOS), over 90% of patients experience significant pain relief and improved mobility after total knee replacement.
The American Journal of Bone and Joint Surgery reports that more than 80% of knee implants last at least 20 years. Success rates are even higher when patients follow recommended rehabilitation protocols and maintain a healthy weight post-surgery.
In Raleigh, access to experienced orthopedic surgeons and advanced surgical technology contributes to high success rates. Facilities like Duke Raleigh Hospital offer robotic-assisted knee replacements, which may improve implant alignment and reduce recovery time for some patients.
Are there affordable alternatives to knee replacement?
Yes, several non-surgical and minimally invasive options may be considered before knee replacement. According to the American Academy of Orthopaedic Surgeons (AAOS), alternatives include physical therapy, corticosteroid injections, hyaluronic acid injections, platelet-rich plasma (PRP) therapy, and lifestyle modifications such as weight loss and low-impact exercise.
These treatments can provide temporary relief and may delay the need for surgery, especially in early-stage osteoarthritis. Costs vary: physical therapy sessions in Raleigh average $100–$150 per visit, while injections can range from $500 to $2,000 depending on the type and number of treatments.
However, these options are generally not long-term solutions if joint damage is severe. Patients should consult an orthopedic