What do payers pay orthopedics groups in GA?

Across 607 NPIs, the median published rate is 116.8% of locality-adjusted Medicare (September 2026 files).

Data as of the September 2026 payer files.

Across 137 procedure codes and 3 payers, the median published rate is 152 percent of locality-adjusted Medicare in the September 2026 payer files. Cigna publishes the highest median at 177 percent and Aetna the lowest at 118 percent, a spread of 59 points on identical work. 3 of 3 payers sit at or above Medicare. The best-covered row rests on 607 confirmed NPIs, and any combination under five is withheld rather than shown thin. These are contracted amounts the payer published, not what a practice was paid, and every row clears the ghost-rate filter, so each NPI counted here actually billed the code in the Medicare utilization file.

Published rates

What do payers pay orthopedics groups in GA?
Payer	Code	Site	n	p25	p50	p75	% of Medicare
Cigna	99213	professional	607	80.95	111.37	145.14	116.8%
UnitedHealthcare	99213	professional	592	87.52	116.16	136.46	120.1%
Cigna	99214	professional	573	123.98	164.6	208.99	121.5%
UnitedHealthcare	99214	professional	558	130.73	172.61	196.07	125.3%
Aetna	99213	professional	556	36	73.51	119.36	101.9%
Aetna	99214	professional	515	44.01	109.16	176.55	101.2%
Cigna	99203	professional	465	115.72	162.13	175.6	135.4%
Aetna	20610	professional	460	27.73	46.58	83.1	142.4%
UnitedHealthcare	99203	professional	451	121.16	166.02	184.2	140.9%
Cigna	20610	professional	450	92.98	110.24	123.78	160.6%
Cigna	99204	professional	448	191.35	252.02	321.74	140.4%
UnitedHealthcare	99204	professional	439	194.38	269.46	299.25	149.8%
UnitedHealthcare	20610	professional	438	89.32	113.37	128.49	170.4%
Aetna	99203	professional	432	39.47	92.1	160.32	105.2%
Aetna	99204	professional	403	43.8	152.31	254.13	107.7%
Cigna	73030	professional	342	20.01	37.64	58.91	177.9%
UnitedHealthcare	73030	professional	329	19.42	33.51	53.62	160.6%
Aetna	73030	professional	311	18.37	33.36	48.05	158.1%
Cigna	73502	professional	284	23.08	52.96	76.27	176.1%
UnitedHealthcare	73502	professional	272	23.01	46.48	75.23	160.6%
Aetna	73502	professional	261	20.66	41.93	65.12	158.8%
Aetna	27447	professional	237	146.51	923.84	2262.82	196.9%
Cigna	73562	professional	229	20.01	46.34	69.34	175.5%
UnitedHealthcare	73562	professional	221	19.41	39.67	65.71	160.7%
Cigna	72100	professional	213	23.73	47.7	71.11	181.6%
UnitedHealthcare	72100	professional	213	23.01	40.76	59.38	160.6%
Cigna	73564	professional	212	23.4	54.28	80.05	175.2%
Aetna	73562	professional	208	18.37	39	56.98	164%
Cigna	27447	professional	206	2428.94	2959.59	3286.72	247.8%
Aetna	72100	professional	205	20.66	36	54.45	157.8%
UnitedHealthcare	73564	professional	202	23.72	45.89	74.77	159.9%
UnitedHealthcare	27447	professional	200	2237.25	2845.95	3119.72	245.5%
Aetna	73564	professional	197	22.85	43.5	63.88	161.8%
Aetna	20550	professional	174	19.73	41.83	78.89	158.4%
Aetna	27130	professional	169	148.52	926.08	2261.92	179.6%
Cigna	99212	professional	169	44.66	55.53	82.28	98.9%
UnitedHealthcare	99212	professional	167	47.1	65.57	75.91	108.4%
Aetna	73721	professional	166	93.73	340	570.84	287.5%
UnitedHealthcare	73721	professional	166	155.12	312.18	469.41	243.7%
Cigna	73721	professional	165	148.72	335.8	561.47	233.6%
Aetna	99212	professional	159	35.9	49.4	78.89	97.8%
Aetna	20600	professional	150	17.24	43.09	78.89	169.3%
Cigna	73130	professional	148	20.46	42.11	68.66	178.8%
Cigna	73110	professional	143	20.46	48.07	72.56	177.3%
UnitedHealthcare	73130	professional	142	17.99	34.91	60.08	155%
Aetna	73130	professional	141	16.44	33	50.7	157.1%
Aetna	20605	professional	136	19.89	40.85	78.89	176.8%
Cigna	20550	professional	135	82.77	94.49	114.08	164.2%
Aetna	73110	professional	135	19.19	36.52	57.68	151.3%
Cigna	27130	professional	134	2273.62	2640.5	3431.8	228.2%
UnitedHealthcare	73110	professional	132	17.99	40.81	66.3	153.5%
UnitedHealthcare	27130	professional	131	2169.14	2780.15	3123.7	242.6%
UnitedHealthcare	20550	professional	130	77.59	107.17	127.15	173.8%
Aetna	73221	professional	121	93.73	338.86	520.09	275.8%
Cigna	73221	professional	120	148.72	336.58	562.36	233.2%
UnitedHealthcare	73221	professional	120	157.54	303.95	447.34	239.7%
UnitedHealthcare	73560	professional	117	16.18	33.17	45.71	152.5%
UnitedHealthcare	72040	professional	116	22.73	42.03	61.68	166.9%
Cigna	73560	professional	116	17.33	36.23	51.04	177.6%
Cigna	73610	professional	116	18.05	45.55	61.57	182.5%
Cigna	72040	professional	115	24.14	48.75	70.78	183.4%
UnitedHealthcare	73610	professional	112	17.99	36.8	57.67	161.6%
Aetna	72040	professional	111	21.56	35.82	52.28	151.8%
UnitedHealthcare	73630	professional	110	17.28	34.29	53.41	160.6%
Aetna	73610	professional	109	16.6	35.26	51.33	152.8%
Aetna	26055	professional	108	71.24	343.1	740.7	127%
Cigna	73630	professional	108	17.34	40.88	58.86	183.1%
Cigna	20600	professional	107	78.99	87.51	104.48	164.6%
Aetna	20611	professional	106	18.14	105.29	209.05	201.2%
Aetna	23472	professional	106	223.24	1116.19	2227.22	86.3%
Aetna	73560	professional	106	15.04	31.58	45.14	150.6%
UnitedHealthcare	20600	professional	104	73.93	98.8	119.62	172.6%
Aetna	72148	professional	104	93.77	309.28	564.71	303.7%
Aetna	73630	professional	104	15.94	33	47.57	153.2%
Cigna	72148	professional	103	162.77	294.82	530.26	235.2%
UnitedHealthcare	72148	professional	103	170.47	280.38	424.28	245.5%
Aetna	29827	professional	102	171.73	825.41	1783.54	104.6%
Aetna	63047	professional	95	184.44	934.1	2020.5	114.5%
Aetna	64721	professional	94	72.77	339.57	806.06	137.4%
Aetna	20552	professional	93	23.46	41	78.2	264.9%
Cigna	20605	professional	93	84.37	91.11	105.46	168.3%
UnitedHealthcare	20605	professional	91	72.25	92.67	104.78	175.8%
Aetna	27245	professional	89	220.97	980.34	1794.88	56%
Aetna	20526	professional	85	30	57.59	128.3	231.4%
Aetna	22612	professional	85	256.74	1379	2373.88	24.8%
Aetna	29824	professional	82	116.52	537.47	1159.38	143.2%
Aetna	27236	professional	78	204.37	953.74	1642.86	46.1%
Aetna	64483	professional	78	40.16	124.55	330.82	144.1%
Aetna	29823	professional	76	102.08	510.4	1208.1	112.4%
Aetna	22633	professional	73	427.94	1478	2521.39	13.1%
Aetna	29828	professional	72	1006.22	1353.91	1835.35	49.7%
Aetna	22551	professional	70	1388.87	2103.75	2985.89	31.5%
Aetna	22558	professional	70	260.77	1288.03	2248.93	12.5%
Aetna	64718	professional	70	98.96	478.68	985.8	129%
Cigna	73080	professional	69	20.1	44.57	60.22	182.5%
Aetna	73080	professional	67	19.19	36	54.9	174.8%
Cigna	26055	professional	66	694.62	866.28	984.33	145.3%
Aetna	29881	professional	66	102.57	465.64	1251.25	104.7%
Aetna	20551	professional	65	29.02	60.64	757.25	2275.8%
UnitedHealthcare	73080	professional	65	17.99	34.75	49.63	161.3%
Cigna	20611	professional	64	118.25	141.02	159.47	136.5%
Cigna	23472	professional	64	2625.05	2957.35	3587.28	230.2%
UnitedHealthcare	26055	professional	64	650.2	901.01	1186.85	148.4%
Cigna	29827	professional	64	1803.27	2175.47	2716.4	221.3%
Aetna	29880	professional	64	96.74	483.68	1313.63	99.9%
UnitedHealthcare	20611	professional	63	116.1	148.35	170.35	150.1%
UnitedHealthcare	23472	professional	63	2421.28	3013.21	3347.92	232.6%
UnitedHealthcare	29827	professional	63	1644.37	2230.69	2462.4	225.1%
Aetna	62323	professional	63	39.64	227.12	924	235.1%
Cigna	99215	professional	62	150.48	245.69	301.97	129.6%
Aetna	20604	professional	61	32.58	105.06	1024	1784.5%
Aetna	64493	professional	61	197.1	764	1243.5	197%
Aetna	20680	professional	60	83.84	400.59	1163.91	97.4%
UnitedHealthcare	99215	professional	60	180.42	245.89	303.28	134.9%
Aetna	62321	professional	59	41.06	263.23	1011.63	238.5%
Aetna	63030	professional	59	209.66	863.63	1691.72	52.5%
Aetna	20606	professional	58	36.32	117.38	1024	1673.9%
Cigna	72110	professional	58	30.22	55.5	86.78	176.5%
Aetna	20553	professional	57	31.29	54.9	918.25	2808.5%
Aetna	25600	professional	57	56.39	263.15	750.5	681.7%
Aetna	25609	professional	57	1197.8	1492.81	2185.94	39.7%
Aetna	26160	professional	57	96.42	455.33	1164.56	139%
Aetna	64490	professional	57	224.02	887.5	1275	197%
Aetna	64635	professional	57	163.59	428.08	974.63	102.9%
UnitedHealthcare	72110	professional	57	26.58	57.06	79.8	173.9%
Aetna	22513	professional	56	777.37	1847.01	2727.85	63.6%
Aetna	27279	professional	56	450.98	938.17	1642.63	10.8%
Aetna	27446	professional	56	255.38	982.94	1656.5	22.1%
Aetna	27487	professional	56	388.34	1446.5	2269.41	16.2%
Aetna	27786	professional	56	53.51	250.49	911	693.7%
Aetna	28470	professional	56	43.05	176.97	911	693.7%
Aetna	29879	professional	56	136.48	559.68	1311.34	86.3%
Aetna	63685	professional	56	84.63	455.35	1159.5	4.7%
Aetna	64450	professional	56	36.45	72.43	961.5	1777.3%
Aetna	64640	professional	56	41.34	191.54	932.13	515.5%
Aetna	64719	professional	56	83.73	445.86	1102.93	122.2%
Aetna	72110	professional	56	28.43	43.25	69.51	164.8%
Aetna	10005	professional	55	33.24	130.5	1024	251.3%
Aetna	11641	professional	55	41.39	174.17	1037.25	718.9%
Aetna	11642	professional	55	42.95	196.98	1144.13	672%
Aetna	11643	professional	55	48.61	232.6	1144.13	606%
Aetna	14040	professional	55	147.46	670.75	1159.5	102.7%
Aetna	14041	professional	55	187.47	787.5	1347.85	117%
Aetna	14060	professional	55	149.59	700.18	1291.41	107.5%
Aetna	14061	professional	55	201.79	787.5	1429.93	118.9%
Aetna	15823	professional	55	95.54	451.41	1363	120.8%
Aetna	21320	professional	55	42.01	194.86	1037.25	76.9%
Aetna	21555	professional	55	74.59	328.64	1144.13	156.3%
Aetna	22514	professional	55	768.87	1832.01	2704	61.1%
Aetna	22600	professional	55	290.47	1108.68	1872.58	16.1%
Aetna	22630	professional	55	323.32	1297.06	1945.49	10.7%
Aetna	25605	professional	55	90.9	444.58	1213.5	139%
Aetna	27134	professional	55	399.28	1497.73	2294.63	24.7%
Aetna	27486	professional	55	305.17	1201.68	1930.88	29.3%
Aetna	29806	professional	55	213.47	907.54	1601.41	45.8%
Aetna	29807	professional	55	216.56	854.24	1520.85	46.1%
Aetna	29822	professional	55	117.3	573.26	1222.5	79.7%
Aetna	29825	professional	55	121.44	519.28	1295.63	83.4%
Aetna	29873	professional	55	101.42	460.8	1213.5	79.7%
Aetna	29877	professional	55	128.26	548.63	1339	83.4%
Aetna	29888	professional	55	201.28	837.29	1497.5	34.7%
Aetna	31575	professional	55	37.65	123.42	1130.75	1229.4%
Aetna	32555	professional	55	85.91	367.48	1024	283.4%
Aetna	36561	professional	55	165.2	786.18	1216.23	75.4%
Aetna	36589	professional	55	39.74	142.31	984.25	297.2%
Aetna	38222	professional	55	43.41	177.95	1024	78.2%
Aetna	38510	professional	55	88.94	406.06	1144.13	72.3%
Aetna	43235	professional	55	47.92	270.52	971.5	196.1%
Aetna	43239	professional	55	55.49	335.63	1130.75	228.8%
Aetna	43249	professional	55	74.56	353.19	1159.5	129.7%
Aetna	45378	professional	55	83.19	228.47	1026.75	223.1%
Aetna	45380	professional	55	66.51	431.9	1130.75	173.4%
Aetna	45381	professional	55	66.88	426.08	1130.75	173.4%
Aetna	45385	professional	55	72.41	451.17	1130.75	173.4%
Aetna	50590	professional	55	130.8	626.87	2022.75	119.5%
Aetna	51715	professional	55	58.57	327.22	1213.5	51%
Aetna	51729	professional	55	309.05	613.89	1024	441.4%
Aetna	52000	professional	55	41.39	212.6	971.5	314.4%
Aetna	52005	professional	55	52.04	271.03	1130.75	113.7%
Aetna	52260	professional	55	41.39	245.99	1159.5	115.7%
Aetna	52276	professional	55	53.63	334.38	1213.5	121.1%
Aetna	52281	professional	55	55.04	315.76	1159.5	115.7%
Aetna	52310	professional	55	52.89	278.7	1130.75	113.7%
Aetna	52332	professional	55	61.69	373.12	1130.75	66.1%
Aetna	52352	professional	55	64.28	412.1	1339	77.7%
Aetna	52356	professional	55	155	583.95	1364.59	49.1%
Aetna	52601	professional	55	160.27	761.37	1339	50.6%
Aetna	52630	professional	55	98.8	533.51	1144.13	42.5%
Aetna	54150	professional	55	38.1	149.88	940.25	95.5%
Aetna	54161	professional	55	49.01	239.85	1089	115.7%
Aetna	54530	professional	55	119.94	572.37	1339	76.8%
Aetna	55250	professional	55	63.11	317.9	1089	115.7%
Aetna	57260	professional	55	129.26	646.29	1361.5	60.5%
Aetna	57282	professional	55	115.17	575.86	1351	42.5%
Aetna	57287	professional	55	153.39	750.35	1366.5	79.9%
Aetna	57288	professional	55	129.86	649.29	1360	46.1%
Aetna	63267	professional	55	299.55	1199.29	1844.3	52%
Aetna	63650	professional	55	317.32	1057.74	1545.68	29.8%
Aetna	63655	professional	55	190.35	847.5	1660.92	12.1%
Aetna	64445	professional	55	36.15	118.51	971.5	790.5%

Median rate by payer, percent of Medicare

Solid line 100% of Medicare.

How this is measured

Rates come from each payer's published Transparency in Coverage machine-readable file, filtered to this specialty's codes and to NPIs the CMS Medicare utilization file shows billing that code. Percentiles are computed per payer, code and site of service across those NPIs, then divided by the locality-adjusted Medicare amount for the same code and place. Full methodology.

Payer files: 2026-09

Questions

Is this what the practice was paid?

No. These are contracted rates as published by the payer, not allowed or paid amounts.

Why are some cells blank?

Ghost rates are removed using Medicare utilization. A row appears only if that NPI billed the code.

What is an episode total?

Professional plus facility when both exist. We never average them or invent a total from one side.

Saran Siva

Co-founder & CTO, Insight Health · September 2026 files