Key takeaways:
- Tommy John surgery (UCL reconstruction) and UCL repair are billed under different procedure codes, 24346 and 24345, and the repair is usually the simpler and cheaper of the two.
- In one large study, athletes returned to competition after about 9 months with a repair against about 13 months with reconstruction, at similar return rates.
- Repair is not right for every tear, and one study of early-career surgeons found a higher complication rate after repair.
- If you run a sports medicine practice, I also cover what these numbers mean for the parents who are searching for prices right now.
When I reviewed the pages that rank for this comparison, the surgeon pages explained both operations well but gave no cost figures at all, and one of the top results listed prices in rupees. This page puts both side by side.
What each surgery is
The ulnar collateral ligament (UCL) holds the inside of the elbow together. Throwing athletes, especially pitchers, stretch and tear it.
UCL reconstruction, known as Tommy John surgery, replaces the torn ligament with a tendon graft, usually taken from the patient’s own forearm or leg. It is billed as CPT 24346.
UCL repair keeps the patient’s own ligament, reattaches it, and usually reinforces it with a strong collagen-coated tape called an internal brace. It is billed as CPT 24345, the code for repair with local tissue. (Arthroscopy, Sports Medicine, and Rehabilitation, 2023)
Repair generally suits a ligament torn off at one end with good tissue left. Reconstruction is used when the ligament itself is worn or damaged along its length.
What each surgery costs
Published prices are rare for both, but a few exist.
| UCL repair | Tommy John (reconstruction) | |
|---|---|---|
| Procedure code | CPT 24345 | CPT 24346 |
| Example posted self-pay price | $4,435 all-inclusive (surgery center, Ohio) | $8,178 bundled (orthopedic practice, Houston) |
| Hospital price files, median cash price | Not reported | $6,929 |
| Hospital price files, median negotiated rate | Not reported | $13,342 |
The Orthopaedic Surgery Center in Youngstown, Ohio lists UCL repair at $4,435 for self-pay patients, as one charge covering the facility, surgeon and anesthesiologist. (The Orthopaedic Surgery Center price list) Movement Orthopaedic in Houston lists open elbow UCL reconstruction at $8,178 as a bundled fee. (Movement Orthopaedic surgery pricing)
For reconstruction specifically, an analysis of 2026 hospital price transparency files found a median cash price of $6,929, a median gross charge of $19,248 and a median insurer-negotiated rate of $13,342. The authors note these exclude surgeon fees, anesthesia, imaging and rehab billed separately. (The Pricer, 2026)
Two practical points for families: a surgery center is usually cheaper than a hospital, and whether you have met your deductible will decide your bill more than which surgery is chosen.
Recovery and return to play, side by side
The largest comparison so far followed 461 competitive athletes, average age 19, treated at one center. (Dugas et al., American Journal of Sports Medicine, 2025)
| UCL repair with internal brace | Reconstruction | |
|---|---|---|
| Returned to their sport | 98% (241 of 247) | 99% (145 of 147) |
| Time to return to practice | 6.7 months | 10.2 months |
| Time to return to competition | 9.2 months | 13.4 months |
| Revision rate | 9% | 8% |
The return to competition and revision figures are as reported by Healio. (Healio, February 2025)
For a high school or college athlete, four months sooner back on the field can mean a season. That is often worth more to a family than any difference in the surgical bill.
The trade-off nobody puts on the price page
Repair is not simply the better option. A study of cases reported by early-career orthopedic surgeons sitting their board exams from 2010 to 2020 found a cumulative complication rate of 25% after repair against 11.6% after reconstruction. (Arthroscopy, Sports Medicine, and Rehabilitation, 2023)
That group is early in practice, and results in experienced hands may differ. It is still a good reason to ask any surgeon how many of each operation they do and what their own complication rate is.
The cost of a long recovery, at the highest level
At the professional level the bill looks very different. A study of 194 Major League pitchers who had reconstruction between 2004 and 2014 found they missed an average of 180 days of the regular season, and only 77% returned to MLB play. The cost of recovery to teams averaged $1.9 million per player. (Journal of Shoulder and Elbow Surgery, 2019)
For most families the numbers are smaller, but the logic is the same: time away from play is part of the cost.
Questions to ask before you choose
- Is my tear repairable, or does it need a graft? The imaging and the tissue quality decide.
- How many of each operation does the surgeon do a year, and what are their complication rates?
- Where will surgery happen, and is there a self-pay price? Some surgery centers publish one.
- What does the estimate include? Surgeon, facility, anesthesia, the brace or graft, imaging and physical therapy are often billed separately.
- What is the rehab plan, and who runs it? Months of therapy are part of both the result and the cost.
If the shoulder is also involved, my pages on labrum surgery cost and shoulder arthroscopy cost cover the most common related procedures. For another common sports reconstruction, see ACL reconstruction cost.
What this means if you run a sports medicine practice
Some facts, side by side.
The share of UCL surgeries done as repairs rose from 10% in 2010 to 38% in 2020 among early-career surgeons, and in New York State repairs grew 133% between 2017 and 2021 while reconstructions grew 48%. Patients 16 and younger had a repair 40.9% of the time. (Orthopaedic Journal of Sports Medicine, 2025)
Patients aged 16 to 20 accounted for 67.4% of UCL reconstructions in a national commercial insurance study, and the rate of the surgery kept rising in younger age groups. (Arthroscopy, Sports Medicine, and Rehabilitation, 2020)
The people researching these operations online are often parents of teenagers, and the surgeon pages ranking for the comparison show no prices, while a few surgery centers publish theirs.
How those fit together for your practice is your decision. The families are already searching, and right now they are comparing you against pages that leave the cost question unanswered.
If you want to see what your elbow and sports medicine pages look like from a parent’s side, book a 20-minute call. I will look at your site and your market before we talk. You can also read what a page like this is worth to an orthopedic practice.
Frequently asked questions
How much does Tommy John surgery cost without insurance? Posted self-pay prices vary. One Houston practice lists $8,178 bundled, and an analysis of hospital price files found a median cash price of $6,929 for the hospital portion alone.
Is UCL repair cheaper than reconstruction? Usually. It uses a different procedure code and no tendon graft, and one Ohio surgery center lists an all-inclusive self-pay price of $4,435.
How long until a pitcher competes again after each surgery? In a study of 461 athletes, about 9.2 months after repair against 13.4 months after reconstruction.
Is UCL repair as good as Tommy John surgery? Return-to-sport rates were similar, about 98% and 99%, in the largest study. One study of early-career surgeons found more complications after repair, so the surgeon’s experience matters.
Why are more teenagers having UCL surgery? Rates have risen fastest in younger age groups, and patients 16 to 20 made up 67.4% of reconstructions in one national study.
