What do payers pay orthopedics groups in TN?

Across 490 NPIs, the median published rate is 107.8% of locality-adjusted Medicare (September 2026 files).

Data as of the September 2026 payer files.

Across 73 procedure codes and 3 payers, the median published rate is 167 percent of locality-adjusted Medicare in the September 2026 payer files. Cigna publishes the highest median at 173 percent and Aetna the lowest at 164 percent, a spread of 9 points on identical work. 3 of 3 payers sit at or above Medicare. The best-covered row rests on 490 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 TN?
Payer	Code	Site	n	p25	p50	p75	% of Medicare
Cigna	99213	professional	490	80.62	96.36	103.87	107.8%
UnitedHealthcare	99213	professional	482	81.48	100.42	147.15	112.4%
Aetna	99213	professional	475	48	72.48	127.64	102.2%
Cigna	99214	professional	465	128.76	142.48	154.16	111.9%
UnitedHealthcare	99214	professional	456	128.07	149.64	210.94	117.6%
Aetna	99214	professional	449	53.17	107.44	188.29	105.4%
Cigna	99204	professional	385	181.79	218.1	235.45	131.3%
UnitedHealthcare	99204	professional	379	206.89	236.3	343.07	142.2%
Aetna	99204	professional	373	60.14	165.12	286.55	114.8%
Cigna	20610	professional	351	80.71	97.85	119.68	154.7%
Aetna	20610	professional	348	21.66	55.67	89.87	139.5%
UnitedHealthcare	20610	professional	345	83.01	100.29	139.04	158.6%
Cigna	99203	professional	330	115.4	138.62	153.67	126.3%
UnitedHealthcare	99203	professional	326	128.92	150.23	201.23	136.9%
Aetna	99203	professional	319	48	107.59	198.78	123.8%
Cigna	73030	professional	255	16.09	28.37	39.04	131.5%
Cigna	73502	professional	252	19.15	40.1	53.79	141.3%
UnitedHealthcare	73030	professional	250	18.23	28.58	40.32	135.8%
Aetna	73030	professional	248	15.23	28.42	48	137.4%
UnitedHealthcare	73502	professional	248	21.93	41.14	56.48	137.7%
Aetna	73502	professional	232	22.13	42.71	66.78	153.2%
Cigna	73562	professional	205	16.22	35.04	45.11	136.7%
UnitedHealthcare	73562	professional	202	18.28	35.84	48.23	132.9%
Aetna	73562	professional	200	18.34	36.66	58.11	140.1%
Aetna	27447	professional	182	168.09	808.5	1923.14	210.4%
UnitedHealthcare	27447	professional	178	2264.11	2520.05	3109.1	237.3%
Cigna	27447	professional	177	2001.26	2364.77	2721.04	221.2%
Cigna	72100	professional	161	19.28	32.69	46.34	142.7%
UnitedHealthcare	72100	professional	156	21.88	35.62	52.7	142.1%
Cigna	73564	professional	156	19.17	40.36	55.2	134.9%
UnitedHealthcare	73564	professional	156	20.46	39.68	54.44	133.6%
Aetna	72100	professional	154	21.94	36.35	55.42	160.1%
Aetna	73564	professional	153	21.94	44.41	65.72	144.7%
Cigna	99212	professional	146	48.3	55.47	61.6	100.1%
Aetna	99212	professional	144	21.3	49.61	81.95	91.6%
UnitedHealthcare	99212	professional	144	48.41	59.13	70.85	106.7%
Cigna	73721	professional	132	118.72	269.08	543.91	209.4%
UnitedHealthcare	73721	professional	132	151.24	254.86	339.81	251.1%
Aetna	73721	professional	131	114.27	334.12	963.49	291.5%
Aetna	27130	professional	126	170.87	854.33	1958.04	198.3%
UnitedHealthcare	27130	professional	122	2132.97	2522.68	2908.48	237.1%
Cigna	27130	professional	120	2057.23	2335.54	2722.16	219.5%
Cigna	73130	professional	115	14.9	32.65	42.65	137.6%
UnitedHealthcare	73130	professional	112	18.09	31.62	42.61	134.6%
Cigna	73560	professional	109	14.87	29.24	39.32	145.9%
Aetna	73130	professional	108	17.03	32.14	53.69	157.5%
UnitedHealthcare	73560	professional	107	17.23	29.31	40.49	139.7%
Aetna	73560	professional	105	14.15	29.2	48.89	139%
Aetna	20550	professional	104	21.3	52.7	94.8	155%
UnitedHealthcare	20550	professional	102	83.39	88.69	117.24	160.6%
Cigna	20550	professional	101	75.73	90.78	103.63	169.1%
Cigna	73610	professional	98	15.03	33.6	45.28	142.6%
Aetna	73221	professional	97	133.89	348.09	963.49	299.9%
Cigna	73221	professional	97	119.3	269.08	544.2	208.9%
UnitedHealthcare	73221	professional	97	152.81	276.99	362.22	252.5%
UnitedHealthcare	73610	professional	97	17.42	31.62	42.44	135.6%
Aetna	73610	professional	96	17.08	34.06	54.01	164.2%
Cigna	73110	professional	95	15.03	37.15	47.53	138%
UnitedHealthcare	73110	professional	94	18.79	36.7	53.08	136.1%
Cigna	72148	professional	93	129.98	237.29	482.21	212.3%
Cigna	99215	professional	92	177.21	205.11	225.42	113.5%
UnitedHealthcare	99215	professional	92	167.12	195.85	230.91	108.4%
Aetna	72148	professional	91	119.39	327.12	963.49	320%
UnitedHealthcare	72148	professional	91	165.73	263.07	344.01	252.5%
Aetna	73110	professional	91	17.08	38.29	61.76	158.1%
Aetna	99215	professional	90	62.13	128.43	208.68	104.3%
Cigna	72040	professional	83	19.28	32.65	48.21	149.8%
Cigna	73630	professional	82	14.34	29.89	42.36	145.3%
Aetna	20605	professional	81	28.14	54.1	95.47	180.4%
UnitedHealthcare	20605	professional	80	78.6	85.54	123.74	167.7%
Aetna	72040	professional	80	22.13	41.02	57	199.1%
UnitedHealthcare	72040	professional	80	23.46	35.2	51.93	154.2%
Cigna	20605	professional	79	74.2	96.86	98.03	183%
UnitedHealthcare	73630	professional	79	17.42	29.95	41.13	144.5%
Aetna	73630	professional	78	16.42	33.6	50.17	189.1%
Aetna	23472	professional	70	214.21	963.42	1840.1	184.7%
Aetna	20600	professional	68	27.62	52.05	91.85	153.7%
UnitedHealthcare	20600	professional	66	74.1	81.25	105.52	157%
Cigna	20600	professional	65	67.88	86.25	94.31	166%
Aetna	64721	professional	64	80.19	282.8	564.24	164.4%
UnitedHealthcare	23472	professional	63	2248.97	2705.17	3989.34	226.7%
Cigna	23472	professional	62	2211.96	2425.63	2922.28	203.1%
UnitedHealthcare	64721	professional	62	718.94	799.07	1178.4	180.7%
Cigna	64721	professional	61	642.63	739.55	970.23	164.9%
Aetna	26055	professional	56	83.02	292.1	677.4	148.7%
Aetna	27245	professional	55	154.48	752.96	1158.62	177.2%
Aetna	20611	professional	54	15.1	50.34	120.15	132%
UnitedHealthcare	26055	professional	54	736.32	857.99	1128.82	149.4%
Aetna	29827	professional	54	165.56	772.59	1628.09	181.8%
Cigna	26055	professional	53	650.12	794.72	828.01	138.4%
Cigna	27245	professional	53	1677.54	2026.94	2107.84	197.9%
UnitedHealthcare	27245	professional	52	1940.83	2207.08	2381.14	213.2%
Cigna	20611	professional	50	105.36	127.23	130.87	132.2%
UnitedHealthcare	20611	professional	50	119.87	140.86	144.17	146.4%
Aetna	29826	professional	50	43.77	109.43	228.54	202.9%
Cigna	29826	professional	49	261.39	416.63	880.04	306.6%
UnitedHealthcare	29826	professional	49	276.59	326.2	481.05	240%
UnitedHealthcare	29827	professional	47	1693.8	1990.38	2306.1	222.2%
Cigna	29827	professional	46	1556.64	1743.02	2125.92	194.6%
Cigna	96372	professional	45	20.67	28.33	34.47	197.3%
Aetna	72110	professional	44	25.69	44.9	73.3	159.4%
Cigna	72110	professional	44	26.93	45.28	61.65	144.1%
UnitedHealthcare	72110	professional	44	28.03	48.23	69.88	159.4%
Cigna	73552	professional	44	15.75	32.98	48.01	153.1%
Cigna	97110	professional	44	43.89	49.8	49.8	180.1%
UnitedHealthcare	73552	professional	43	15.25	31.98	42.98	140%
Aetna	27236	professional	42	150.24	663.34	1126.81	152.1%
Aetna	73552	professional	42	17.94	33.6	49.54	150.8%
Aetna	96372	professional	42	17.98	19.1	30.82	133%
UnitedHealthcare	96372	professional	42	24.42	26.8	38.61	186.7%
UnitedHealthcare	97110	professional	42	40.31	43.55	53.28	157.5%
Aetna	97110	professional	41	45.24	45.62	45.62	164.9%
Aetna	63047	professional	40	150.03	1000.19	2401.98	175.4%
Cigna	99205	professional	40	250.8	315.24	329.06	142.4%
UnitedHealthcare	99205	professional	40	204.17	270.98	435.82	122.4%
Aetna	99205	professional	39	67.27	95.6	390.31	178%
Cigna	22853	professional	37	368.55	406.24	514.64	199.1%
UnitedHealthcare	22853	professional	37	415.48	509.18	698.21	249.6%
Cigna	27236	professional	37	1814.4	2020.24	2122.63	200.5%
Aetna	29823	professional	37	95.6	395.06	903.79	184.1%
Cigna	97140	professional	37	40.82	45.86	45.86	173.8%
Cigna	97530	professional	37	56.42	63.37	63.37	191.5%
UnitedHealthcare	27236	professional	36	1543.64	2205.72	2208.74	220.8%
UnitedHealthcare	63047	professional	36	1702.04	2116.63	2963.56	217.9%
Cigna	73080	professional	36	15.03	31.35	43.72	150.5%
UnitedHealthcare	73080	professional	36	18.79	32.8	43.67	151%
Cigna	63047	professional	35	1697.45	2015.87	2416.42	211.4%
UnitedHealthcare	97140	professional	35	38.82	50.42	50.42	191.1%
UnitedHealthcare	97530	professional	35	46.76	47.42	55.9	143.3%
Aetna	22853	professional	34	44.67	167.52	383.25	196%
Aetna	73080	professional	34	18.72	33.84	45.62	159.9%
Aetna	97140	professional	34	42.01	42.01	42.01	159.2%
Aetna	97530	professional	34	58.53	58.53	58.53	176.9%
Aetna	20526	professional	33	43.17	70.75	142.98	176.9%
Aetna	22612	professional	32	207.74	1164.83	2479.07	177.2%
Aetna	29824	professional	32	104.79	426.73	853.45	180.9%
Cigna	22842	professional	30	1118.59	1496.9	1727.02	247.2%
UnitedHealthcare	22842	professional	30	1348.63	1594.59	2061.9	263.3%
UnitedHealthcare	29823	professional	30	814.2	1156.2	1617.83	222%
UnitedHealthcare	20526	professional	29	110.45	126.02	153.81	155.9%
Aetna	22842	professional	29	98.92	494.6	1074.27	194.9%
Cigna	29823	professional	29	884.08	1044.33	1241.82	202.3%
Cigna	97112	professional	29	57.2	57.2	57.2	183.6%
Cigna	20526	professional	28	108	132.06	152.48	171.4%
Aetna	72141	professional	28	153.09	550	963.49	400.1%
Cigna	72141	professional	28	129.4	239.6	385.06	208.1%
UnitedHealthcare	72141	professional	28	165.73	263.63	323.26	253.7%
Aetna	97112	professional	28	52.91	52.91	52.91	169.9%
UnitedHealthcare	97112	professional	28	44.97	55.98	55.98	179.7%
UnitedHealthcare	22612	professional	27	2380.86	2888.27	3269.52	214.9%
Aetna	22633	professional	27	340.27	1206.18	2268.46	148.2%
Cigna	22612	professional	26	2280.93	2497.58	3354.45	180.4%
UnitedHealthcare	29824	professional	26	851.39	1160.55	1522.42	192.1%
Aetna	29881	professional	26	100.38	394.37	686.07	155.5%
Cigna	73501	professional	26	16.09	31.39	43.65	150.2%
UnitedHealthcare	73501	professional	26	17.4	26.85	40.51	137.5%
Cigna	29824	professional	25	983.33	1015.27	1339.3	173.4%
Cigna	22840	professional	24	1107.08	1514.03	1738.99	253.2%
UnitedHealthcare	22840	professional	24	1222.85	1542.61	2054.13	258%
Aetna	73501	professional	24	18.6	38.77	46.15	192.7%
Aetna	20551	professional	23	9.24	39.41	57.53	138.1%
Aetna	22840	professional	23	98.55	919.82	1417.54	221.4%
Cigna	72070	professional	23	16.23	28.9	40.28	143.3%
Aetna	22558	professional	22	232.1	1003.61	2395.28	146%
Cigna	22614	professional	21	558.39	778.75	915.64	250.6%
UnitedHealthcare	22614	professional	21	716.9	817.18	1057.22	262.9%
UnitedHealthcare	22633	professional	21	2867.44	3707.4	4993.7	244%
Aetna	29828	professional	21	928.17	1650	1998.42	119.9%
Aetna	72070	professional	21	20.91	36.6	48	161.6%
UnitedHealthcare	72070	professional	21	20.85	29.51	44.11	159.3%
Aetna	22614	professional	20	67.63	253.6	483.16	190.7%
Cigna	22633	professional	20	2703.39	3442.03	4324.89	202.3%
Aetna	27487	professional	20	310.68	1165.04	3312.46	115.6%
UnitedHealthcare	29881	professional	20	812.73	1002.38	1478.23	208.1%
Aetna	64718	professional	20	116.41	591.97	1320.96	234%
Aetna	27446	professional	19	276.86	1082.42	2181.52	116.3%
Cigna	29881	professional	19	791.84	1007.81	1081.64	213.4%
UnitedHealthcare	20551	professional	18	84.99	88.37	128.19	160.4%
Aetna	20552	professional	18	25.13	49.76	96.35	209.9%
Aetna	22551	professional	18	1797.3	2797.81	3963.75	84.6%
Aetna	26160	professional	18	94.21	420.46	715.42	137.7%
Cigna	20551	professional	17	71.92	84.25	105.76	171%
UnitedHealthcare	22558	professional	17	2393.95	2795.85	3247.82	213.3%
Cigna	22558	professional	16	2161.93	2657.87	3310.23	175.7%
Aetna	61783	professional	16	284.57	370.29	500.23	218%
Cigna	61783	professional	16	333.25	396.88	538.18	216.4%
UnitedHealthcare	61783	professional	16	358.79	404.71	487.82	220.7%
Aetna	20606	professional	15	17.87	68.66	123	215.8%
UnitedHealthcare	27446	professional	15	1922.36	2155.02	2261.58	224.7%
UnitedHealthcare	27487	professional	15	2785.31	3684.68	4829.2	255.5%
Aetna	29880	professional	15	104.13	469.65	975.22	164.1%
Aetna	63048	professional	15	95.1	212.04	317.96	188.3%
Cigna	63048	professional	15	316.16	389.22	398.64	233.2%
UnitedHealthcare	63048	professional	15	336.45	426.15	569.64	255.3%
Aetna	64483	professional	15	47.08	125.81	395.77	166%
UnitedHealthcare	64718	professional	15	947.92	1100	1445.94	208.9%
Aetna	20680	professional	14	96.39	326.37	796.14	190.6%
Cigna	27487	professional	14	3304.35	3707.55	3958.11	244.9%
UnitedHealthcare	29828	professional	14	1155.6	1600.48	2396.96	172.6%
Cigna	63052	professional	14	382.59	542.97	605.37	265.3%

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