Orthopedic surgery · Pennsylvania
Orthopedic surgery commercial reimbursement in Pennsylvania
How Pennsylvania orthopedic surgery rates compare with the national market.
Orthopedic surgery in Pennsylvania
39 codes · 104 sampled providers
Index vs national
97
3% below
Rank among states
27 of 51
1 = highest
Codes above national
12 of 39
median code at 97%
Providers
104
sampled
What the data shows
1
Orthopedic surgery ranks 27th of 51 states in Pennsylvania with an index of 97 (100 = the specialty's national median), across 39 codes and 104 sampled providers.
2
Of the 39 orthopedic surgery codes with enough data in Pennsylvania, 12 pay above the national median and 27 below; the typical code sits at 97% of the national median.
3
Largest premium over the national median: CPT 97110 (Therapeutic exercises) at 105%; largest discount: CPT 72148 (Mri lumbar spine w/o dye) at 89%.
4
Measured against Medicare, Pennsylvania orthopedic surgery rates have a median of 145% of the Medicare rate across these codes.
Codes above and below the national median
The five largest gaps in each direction
Highest vs national
All orthopedic surgery codes in Pennsylvania
Median across payers vs the specialty's national median and the Medicare rate; sorted by premium
| Code | Pennsylvania | National | Gap | % of Medicare | Providers | TINs | Level |
|---|---|---|---|---|---|---|---|
| CPT 97110 Therapeutic exercises | $33 | $31 | +5% | 114% | 99 | 129 | |
| CPT 99203 Office o/p new low 30 min | $128 | $123 | +5% | 109% | 103 | 135 | |
| CPT 99204 Office o/p new mod 45 min | $199 | $194 | +3% | 112% | 103 | 129 | |
| CPT 99212 Office o/p est sf 10 min | $52 | $51 | +2% | 88% | 103 | 132 | |
| CPT 99205 Office o/p new hi 60 min | $257 | $252 | +2% | 108% | 103 | 129 | |
| CPT 20610 Drain/inj joint/bursa w/o us | $87 | $85 | +2% | 126% | 104 | 155 | |
| CPT 20550 Njx 1 tendon sheath/ligament | $75 | $74 | +1% | 124% | 104 | 155 | |
| CPT 99214 Office o/p est mod 30 min | $133 | $132 | +1% | 98% | 103 | 127 | |
| CPT 99215 Office o/p est hi 40 min | $187 | $185 | +1% | 97% | 103 | 127 | |
| CPT 20611 Drain/inj joint/bursa w/us | $117 | $117 | +1% | 234% | 103 | 154 | |
| CPT 64721 Carpal tunnel surgery | $702 | $700 | +0% | 145% | 104 | 155 | |
| CPT 73630 X-ray exam of foot | $45 | $44 | +0% | 131% | 103 | 152 | |
| CPT 73564 X-ray exam knee 4 or more | $60 | $60 | -0% | 121% | 103 | 153 | |
| CPT 99213 Office o/p est low 20 min | $90 | $91 | -1% | 94% | 103 | 132 | |
| CPT 73030 X-ray exam of shoulder | $45 | $45 | -1% | 125% | 103 | 151 | |
| CPT 73502 X-ray exam hip uni 2-3 views | $59 | $60 | -2% | 121% | 102 | 152 | |
| CPT 72100 X-ray exam l-s spine 2/3 vws | $52 | $53 | -3% | 128% | 103 | 153 | |
| CPT 73562 X-ray exam of knee 3 | $51 | $53 | -3% | 121% | 103 | 153 | |
| CPT 73610 X-ray exam of ankle | $46 | $47 | -3% | 123% | 103 | 152 | |
| CPT 93000 Electrocardiogram complete | $25 | $25 | -3% | 160% | 102 | 151 | |
| CPT 22612 Arthrd pst tq 1ntrspc lumbar | $2,467 | $2,557 | -4% | 168% | 102 | 153 | |
| CPT 72110 X-ray exam l-2 spine 4/>vws | $68 | $71 | -4% | 127% | 102 | 150 | |
| CPT 22551 Arthrd ant ntrbdy cervical | $2,675 | $2,778 | -4% | 167% | 102 | 151 | |
| CPT 27487 Revise/replace knee joint | $2,719 | $2,840 | -4% | 173% | 102 | 151 | |
| CPT 29827 Sho arthrs srg rt8tr cuf rpr | $1,625 | $1,701 | -4% | 166% | 103 | 155 | |
| CPT 73560 X-ray exam of knee 1 or 2 | $43 | $45 | -5% | 124% | 103 | 153 | |
| CPT 27130 Total hip arthroplasty | $2,055 | $2,158 | -5% | 177% | 103 | 155 | |
| CPT 27447 Total knee arthroplasty | $2,072 | $2,190 | -5% | 179% | 103 | 154 | |
| CPT 26055 Incise finger tendon sheath | $580 | $614 | -5% | 202% | 103 | 127 | |
| CPT 22633 Arthrd cmbn 1ntrspc lumbar | $2,823 | $2,991 | -6% | 166% | 103 | 154 | |
| CPT 22558 Arthrd ant ntrbd min dsc lum | $2,313 | $2,471 | -6% | 162% | 101 | 153 | |
| CPT 63047 Lam facetec & foramot lumbar | $1,676 | $1,796 | -7% | 157% | 103 | 154 | |
| CPT 73221 Mri joint upr extrem w/o dye | $351 | $387 | -9% | 171% | 103 | 152 | |
| CPT 29848 Wrist endoscopy/surgery | $740 | $817 | -9% | 152% | 103 | 153 | |
| CPT 73721 Mri jnt of lwr extre w/o dye | $350 | $387 | -9% | 171% | 103 | 153 | |
| CPT 23472 Reconstruct shoulder joint | $2,088 | $2,318 | -10% | 161% | 103 | 155 | |
| CPT 27236 Treat thigh fracture | $1,721 | $1,918 | -10% | 158% | 103 | 152 | |
| CPT 27245 Treat thigh fracture | $1,787 | $1,994 | -10% | 160% | 103 | 153 | |
| CPT 72148 Mri lumbar spine w/o dye | $329 | $370 | -11% | 172% | 103 | 151 |
Frequently asked questions
How do Pennsylvania orthopedic surgery rates compare with the rest of the country?
Pennsylvania ranks 27th of 51 states with an index of 97; 12 of 39 codes are above the national median.
Which orthopedic surgery code has the biggest premium in Pennsylvania?
CPT 97110 (Therapeutic exercises), at 105% of the national median.
Are these Medicare or commercial rates?
Commercial in-network negotiated rates from four national payers' published files; the Medicare comparison column uses the CY2026 Medicare physician fee schedule.
Methodology
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.
Benchmark your Pennsylvania orthopedic surgery contracts
Compare your rates with these medians.