Small surgeries, huge markups 31 Jan 2013 A Southern California surgery center charged teacher Lynne Nielsen $87,500 for a routine, 20-minute knee operation that normally costs about $3,000. Despite the huge markup, the Long Beach Unified School District and its insurer, Blue Shield of California, paid virtually all of the bill from Advanced Surgical Partners in Costa Mesa. Blue Shield mailed the $84,800 check to the high school Spanish teacher last month and told her to sign it over to the surgery center. Nielsen said she was outraged and refused to send the check. Instead, she asked the California attorney general's office to investigate the matter... "This bill is so outrageous it almost takes my breath away," said Gerald Kominski, director of the UCLA Center for Health Policy Research.