Here's a pricing quirk that surprises most orthopedic practices the first time they see it. Nationally, Keyword Planner puts the top-of-page price for "orthopedic near me" at about $2.05 to $11.70 a click. "Knee replacement surgery" runs about $0.75 to $3.03. The vague search costs more than the specific one, and the specific one is the search that fills an operating room.
In our example market, Nashville, the pattern holds across the whole list, not just those two searches. The 74 knee replacement phrasings we pulled had a median high-end bid of $3.44. The 63 generic "orthopedic near me," "orthopedic doctor" and "orthopedic surgeon" phrasings had a median of $5.30.
That gap is the whole chapter. A practice that bids one number across the account pays too much for the vague searches and too little for the valuable ones. A practice that bids each ad group on what its patients are worth does the opposite.
"Knee Replacement Surgery" Is a Cheap Click Because Hospitals and Urgent Cares Aren't Fighting for It
Price in Google Ads comes from competition, and orthopedics has an unusually mixed field. In our example market, the verified Search advertisers we found included three hospital systems, two orthopedic urgent care operators, a national urgent care franchise, Zocdoc and a brace company, alongside the orthopedic groups themselves. A broad search like "orthopedic near me" is one every one of them has a reason to want.
The person typing it could need almost anything. A sprained ankle from this morning. A follow-up for a knee replaced last spring. A records request, a physical therapy appointment, a second opinion on a back surgery someone else recommended. It's popular because it's vague, and expensive because it's popular.
"Knee replacement surgery" is narrow. An urgent care, a booking app or a brace company has little to sell that searcher. The auction that's left is mostly practices and hospitals that actually replace knees, and the searcher has usually already had the conversation with their doctor. Fewer reasons to bid, clearer intent, lower price.
The same split shows up across the example list. Hip replacement searches ran even cheaper than knee. Shoulder and rotator cuff searches sat low as well. Spine searches and hand searches ran high, closer to "near me." Your market will have its own mix, and the auction insights report covered below shows you who's in it.
A caution about these numbers, the same one from Chapter 5: Keyword Planner's top-of-page bids are estimates, roughly right within about 30% either way. They're good for comparing one ad group to another. Your account's real costs replace them within a few weeks.
The Cheapest Click in an Orthopedic Account Can Carry the Biggest Surgery
Now put the value next to the price. For each procedure, Medicare publishes what it pays the surgeon. Using its 2026 fee files, our calculation of the national surgeon fee before local adjustment comes to about $1,159 for a total knee replacement, $1,162 for a total hip, $976 for an arthroscopic rotator cuff repair, $889 for an ACL reconstruction and $1,468 for a lumbar fusion. A new-patient office visit pays about $117 to $177.
Plot price against value and the account sorts itself into corners.
Knee and hip replacement sit in the best corner: low click prices and the biggest surgeon fees outside of spine. Spine is expensive on both axes. And "near me" doesn't get a point at all, because it has no single value. Some of those searchers become a knee replacement. Most become an office visit, a round of physical therapy or nothing.
Commercial insurance pays more than Medicare, and a practice that owns a surgery center also collects a facility payment, as Chapter 3 showed. Those raise every point on the chart. They don't change which corner each ad group sits in.
Rotator Cuff Repair Tops Out Near $5.86 a Click. Spinal Fusion Can Pay $8.81.
Chapter 3 walked the chain from click to surgical patient for a knee. Run every procedure through the same math and each ad group gets its own ceiling, the most you can pay per click and still make money on the patient.
Chapter 3's assumptions stay the same so the numbers line up: spend up to a fifth of the surgeon's fee to win a surgery, a quarter of consults end in surgery, and 12 of every 100 clicks book a consult. These are an illustration, not a forecast. Your own booking rate and surgery rate, once Chapter 1's tracking gives them to you, replace ours.
- Knee replacement: about $6.95 a click.
- Hip replacement: about $6.97.
- Rotator cuff repair: about $5.86.
- ACL reconstruction: about $5.34.
- Lumbar fusion: about $8.81.
"Near me" needs a different surgery rate, because it isn't screened. The searcher hasn't told you what's wrong. Chapter 3 cited a spine practice that took new patients without screening, where 15% ended up in surgery. Give "near me" that rate, and even assume every one of those surgeries is a knee replacement, the best case, and the ceiling drops to about $4.17 a click.
Now set each ceiling beside the market price.
Knee, hip and shoulder have room to spare: the market's high-end price is roughly half the ceiling or less. ACL is tight. Spine fits, barely. "Orthopedic near me" is the only ad group where the going price runs past what its patients can pay for, even on generous assumptions.
That doesn't mean "near me" gets switched off. It means it gets a bid set on purpose, lower than the market wants, while the surgical ad groups get bids high enough to win.
One Bid for the Whole Account Either Overpays for "Near Me" or Loses the Spine Searches
This is why the first campaign runs on bids you set by hand. We call it Isolation, our name, not Google's: the exact match campaign from Chapter 6, running on manual cost-per-click bidding. Google describes manual CPC simply: you set the maximum you're willing to pay for a click, and you can change it whenever the numbers tell you to.
Each ad group from Chapter 4 gets its own maximum: one for knees, one for hips, one for shoulders, one for the spine. A single bid for the whole account can't be right everywhere. Set it high enough to win "near me," around $8 in the example market, and you're paying nearly $8 for patients worth about $4.17 a click. Set it low enough for "near me," around $4, and you drop out of the ACL and spine auctions, where the patients could have paid for more. Only separate bids let knee, hip and shoulder take the top of the page cheaply while "near me" settles for a lower spot on purpose.
Start the surgical ad groups higher than feels comfortable. On launch day the knee ad has no click history for Google to judge it by, so the bid is carrying all the weight. As the ads earn clicks and your pages prove they fit the search, Quality Score builds and the same position gets cheaper. That's when bids come down, one ad group at a time.
A Knee Replacement Ad Should Sit Above the Unpaid Results on 75% to 90% of Searches
Once bids are live, four numbers tell you whether each one is right. Add them as columns at the ad group and keyword level.
Search top impression share: picture every knee replacement search your ad was eligible for this month. This column says what fraction of them saw your ad sitting above the unpaid listings. On the searches that matter most, knee replacement, hip replacement and your best procedure, aim for 75% to 90%. Under that, patients searching for exactly what you do are seeing someone else first.
Search absolute top impression share is the share where you held the very first spot. Nice to have, rarely worth paying extra for.
Search lost impression share (rank): the portion of those chances you missed because the ad ranked too low, whether from the bid, the ad or the page it points to. Its sibling column, lost to budget, counts the chances missed because the day's money was already spent. They call for opposite fixes. Lost to rank on a knee ad group is a reason to raise that ad group's bid or improve its ad and page. Lost to budget is a reason to move money, not raise bids. Google notes one trap: lost to rank doesn't show on the ad group view for a period when the campaign ran out of budget, so check budget first.
Quality Score is read at the keyword, not the account. A knee keyword stuck at 4 out of 10 usually has an ad or a page problem, which no bid will fix. Google's help center treats Quality Score as a warning light for the keyword, not something the auction itself reads, so use it that way.
Hospital Systems Can Afford to Overpay for "Orthopedic Near Me." You Don't Have To.
The auction insights report shows who you're bidding against and how often they beat you. For Search campaigns it reports six measures, from plain impression share to how often a rival's ad sat directly above yours.
When a hospital system shows up high on your "near me" report, remember it may be bidding for reasons a private group doesn't share: filling several service lines at once, keeping its name in front of a whole region. Out-bidding it on the vaguest search in the account is a fight you can win and still lose money on.
So read auction insights ad group by ad group. On knee and hip, where the price sits well under the ceiling, hold your position. On "near me," if the price climbs past what those patients can support, lower the bid and accept a lower spot, or pause the ad group and put the money into the procedure groups where it buys more surgery. Leaving an auction isn't losing it. It's refusing to overpay.
Broad Match's Target Is the Cost per Consult Your Exact Match Keywords Already Paid
Exploration, the broad match campaign from Chapter 6 (again, our name), hands the bidding to Google. Google sets each bid itself, aiming for as many booked consults as it can find at a target cost per acquisition you choose. Since June 2026 the Google Ads interface labels this "Target CPA"; older guides call it Maximize Conversions with a target CPA.
Where does the target come from? From Isolation. By the time Exploration launches, the account has a real cost per booked consult on its exact match searches. That number is the starting target. Google points the same way. For an account with conversion history, its suggested target is what a conversion actually cost over the past 30 days, and it asks you to judge the result across at least 30 conversions.
Resist setting the target low to force cheap consults. Google's own help page warns that a target set too low may make the campaign pass up clicks that would have turned into patients. Start at what Isolation actually paid and adjust from there.
A Booked Consult Isn't a Scheduled Surgery. Listen to the Calls Before Raising a Bid.
Every bid in this chapter rests on the conversions underneath it, and in orthopedics those can mislead. A call that lasts two minutes looks like a new patient. It might be a physical therapy reschedule, a question about a bill or a patient asking about their own surgery date. Chapter 1 covered keeping those out of the count. Bidding is where they do the damage if they slip back in.
So before raising a bid on an ad group that looks like a winner, listen to a sample of its calls. Were they new patients? Did they book? Did any of those consults turn into surgery? An ad group that books follow-up calls at $40 each isn't cheaper than one that books new knee consults at $70. It's just better at looking busy.
Next: What Goes in the Ad Itself
Bids decide whether your ad shows. The ad decides whether anyone clicks it. Chapter 8 turns to what orthopedic patients actually praise in their reviews, and how to put it in the headlines.
The guide home has the full sequence.
For orthopedic groups that hand us their Google Ads management, every ad group is priced on its own surgery before launch, and the columns get read every week after it.
