Hospital charges for orthognathic surgery with rigid fixation were evaluated for 80 patients from a community surgical practice. Although the surgeon can control to some degree the length of stay and charges for room and board, ancillary services, laboratory, radiology, and medicine by altering practice patterns, these charges together are less than 24% of the hospital bill. Seventy-six p ercent of the total hospital charges are generated in the operating room (ie, operating room anesthesia, recovery, and respiratory apparatus). Surgeons have minimal control over these changes. Future negotiations with private and government third parties about reimbursement for orthognathic surgical procedures require a cooeprative effort between the hospital and the surgeons.