An underwater acoustic metasurface with sub-wavelength thickness is designed for acoustic wavefront manipulation. In this paper, a pentamode lattice and a frequency-independent generalized acoustic Snell’s law are introduced to overcome the limitations of narrow bandwidth and low transmittance. The bulk modulus and effective density of each unit cell can be tuned simultaneously, which are modulated to guarantee the achievement of refractive index profile and high transmission. Here, we actualize anomalous refraction, generation of non-diffracting Bessel beam, sub-wavelength flat focusing, and surface wave conversion by constructing inhomogeneous acoustic metasurface. This design approach has potential applications in medical ultrasound imaging and underwater acoustic communications.