The operating room costs $110,000. It can be upgraded ten times just like the rest of the rooms can be. Because it takes so long to see a patient at first though, I like to have two of them otherwise the line up gets backed up and patients begin to leave. The first upgrade usually takes about a half hour. The second upgrade is maybe an hour and a half. The third is four hours and fifty minutes, and the next is about ten hours. You get the idea. It helps to have a second builder for the cost of 200 gems (but sometimes it will go on sale if you wait for the offer to come up, it will at some point).