Orthopedic surgery · specialty benchmark

Orthopedic surgery commercial reimbursement benchmarks

What commercial payers pay for the procedures that matter most to orthopedic surgery practices.

Orthopedic surgery at a glance

5,081 sampled providers

Codes tracked

publishable codes

Median % of Medicare

145%

across codes

Highest state

Alaska

Highest payer

UHC

UnitedHealthcare

Orthopedic surgery rates in this dataset cover 39 procedure codes and 5,081 sampled providers in 51 states, at a median 145% of Medicare.

Alaska has the highest orthopedic surgery index and Texas the lowest.

UnitedHealthcare has the highest orthopedic surgery index and Aetna the lowest.

The biggest revenue code by Medicare allowed dollars is CPT 27447 (Total knee arthroplasty), paid at a 2,190-dollar median, 189% of Medicare.

Ranked by Medicare allowed dollars billed by the specialty

Rank	Code	Median	Medicare	% of Medicare	Providers
1	CPT 27447 Total knee arthroplasty	$2,190	$1,159.35	189%	5,045
2	CPT 99214 Office o/p est mod 30 min	$132	$135.61	97%	5,069
3	CPT 99213 Office o/p est low 20 min	$91	$95.19	95%	5,069
4	CPT 27130 Total hip arthroplasty	$2,158	$1,162.02	186%	5,035
5	CPT 99204 Office o/p new mod 45 min	$194	$177.36	109%	5,068
6	CPT 20610 Drain/inj joint/bursa w/o us	$85	$68.81	124%	5,071
7	CPT 99203 Office o/p new low 30 min	$123	$117.57	105%	5,069
8	CPT 23472 Reconstruct shoulder joint	$2,318	$1,300.30	178%	5,036
9	CPT 27245 Treat thigh fracture	$1,994	$1,118.26	178%	5,048
10	CPT 20611 Drain/inj joint/bursa w/us	$117	$50.10	233%	5,050

Index: 100 = four-payer median for the specialty's codes

Payer	Index	Rank	Highest on
UnitedHealthcare	110	1	67%
Blue Cross Blue Shield	102	2	15%
Cigna	102	3	18%
Aetna	82	4	0%

Index: 100 = the specialty's national median

Rank	State	Index	Codes	Providers
1	Alaska	277	39	65
2	Wisconsin	150	39	100
3	Wyoming	144	39	65
4	South Dakota	138	39	97
5	Nebraska	135	39	95
6	Washington	133	39	101
7	District of Columbia	130	39	35
8	Iowa	129	39	104
9	North Dakota	127	39	46
10	Connecticut	126	39	114
11	Oregon	123	39	94
12	Massachusetts	120	39	111
13	Minnesota	120	39	102
14	New Jersey	114	39	96
15	Georgia	113	39	124
16	Mississippi	111	39	112
17	North Carolina	110	39	128
18	New Hampshire	110	39	118
19	Tennessee	109	39	117
20	Colorado	107	39	107
21	Idaho	106	39	120
22	Vermont	106	39	38
23	Illinois	102	39	106
24	Hawaii	101	39	71
25	Rhode Island	100	39	98
26	Maryland	99	39	106
27	Pennsylvania	97	39	104
28	Montana	97	39	79
29	New York	96	39	111
30	South Carolina	95	39	106
31	Maine	95	39	94
32	Alabama	94	39	118
33	Virginia	94	39	105
34	Delaware	93	39	59
35	Kansas	93	39	109
36	New Mexico	92	39	106
37	West Virginia	92	39	89
38	Utah	91	39	97
39	Arkansas	91	39	120
40	Ohio	89	39	110
41	California	88	39	109
42	Arizona	87	39	99
43	Michigan	87	39	103
44	Nevada	86	39	109
45	Missouri	86	39	112
46	Kentucky	86	39	124
47	Indiana	84	39	115
48	Louisiana	83	39	103
49	Florida	78	39	108
50	Oklahoma	75	39	100
51	Texas	75	39	122

How these numbers are calculated

Source: in-network negotiated-rate files published under the federal Transparency in Coverage rule, August 2026 snapshot: UnitedHealthcare Choice plans (74 files); Aetna commercial plans (70 files); Cigna national PPO (1 files); BCBS licensees' own-network files (5,387 files). Payer comparisons describe these files, not each payer's entire book of business.
Sample: rates come from a random sample of up to 150 providers per state and specialty. Counts on this page are sampled providers and TINs, not totals.
Which providers count: only providers in a specialty relevant to the code, because a rate in a payer file attaches to a provider group and is listed under every provider in that group.
Filters: fee-for-service, professional billing class, no modifier, negotiated or fee-schedule dollar rates. Rates outside 1% to 1,000% of the Medicare rate are excluded.
Statistic: one median rate per provider, then percentiles across providers. A cell is shown only with at least 15 sampled providers and 4 TINs.
Medicare benchmark: CY2026 national physician fee schedule, non-QPP conversion factor, unadjusted for locality. Where the non-facility rate is more than twice the facility rate (office rates that include device or supply cost), the facility rate is used so comparisons are like for like.

See how your negotiated rates compare by code, payer and state.