The national median salary for all nurse practitioners is $132,300 per year (Bureau of Labor Statistics, OEWS, SOC 29-1171, May 2025). Orthopedic NPs in procedure-heavy practices – surgical first-assist, spine surgery, high-volume arthroplasty programs – consistently earn above this baseline, with experienced providers in well-compensated markets reaching $160,000–$185,000. Entry-level orthopedic NP roles in outpatient community practices sit closer to the $115,000–$130,000 range.
This guide breaks down orthopedic NP compensation by work setting, subspecialty, state, and career stage – and compares orthopedic NP salaries to other surgical specialty NP roles. For the full career pathway and certification requirements, see how to become an orthopedic nurse practitioner.
National salary baseline
The BLS OEWS program surveys employers nationwide each year. The May 2025 data for SOC 29-1171 (Nurse Practitioners) – the classification covering all NP specialties – shows the following national figures:
| Metric | Value (BLS OEWS, May 2025) |
|---|---|
| National median annual salary (50th percentile) | $132,300 |
| 10th percentile | $101,340 |
| 25th percentile | $117,990 |
| 75th percentile | $156,700 |
| 90th percentile | $174,420 |
| Median hourly rate | ~$63.61 |
A note on which BLS figure you are reading. The $132,300 median is specific to SOC 29-1171, Nurse Practitioners. The BLS Occupational Outlook Handbook publishes a separate, broader figure for the combined category “Nurse Anesthetists, Nurse Midwives, and Nurse Practitioners,” which is a different population and produces a different number. Salary pages frequently present one as a correction of the other; they measure different things.
The BLS does not break out orthopedic as a distinct NP specialty category – “Nurse Practitioners” is a single SOC code. The orthopedic premium above the national median is documented through specialty salary surveys (AANP, Medscape, and employer-specific data) rather than BLS figures alone. Orthopedic NPs consistently appear in the upper tier of NP specialty compensation benchmarks, alongside cardiology, neurology, and acute care.
Industry salary survey data puts average orthopedic NP compensation modestly above the all-NP median in W-2 employment, with locum tenens orthopedic NPs earning $70–$95 per hour – equivalent to $145,000–$195,000 at sustained full-time volume. Treat any single “average orthopedic NP salary” figure with caution: because no federal dataset isolates the specialty, every such number comes from a self-selected survey panel or a job-board sample rather than from a measured national population.
Salary by work setting
Work setting is one of the strongest predictors of orthopedic NP compensation. The gap between a high-volume surgical first-assist role and an outpatient community orthopedic clinic can exceed $30,000–$40,000 annually.
| Work setting | Estimated annual salary range | Key compensation drivers |
|---|---|---|
| Hospital inpatient orthopedic unit (employed by health system) | $125,000–$155,000 | Union/scale agreements, shift differentials, inpatient complexity, night/weekend premiums |
| Orthopedic surgery private practice (procedure-heavy) | $130,000–$165,000 | Procedural volume (injections, aspiration, surgical first-assist), RVU-based bonus potential, surgeon productivity share |
| Ambulatory surgery center (ASC) | $128,000–$160,000 | Surgical first-assist authorization, case volume, ASC ownership structure, no inpatient call |
| Sports medicine clinic | $110,000–$145,000 | Affiliation with professional/collegiate sports programs carries premium; community outpatient settings are at the lower end |
| VA / federal orthopedic service | $120,000–$148,000 | Federal pay scale (Title 38 hybrid pay), geographic pay tables, no call requirement in most VA settings, strong benefits/pension |
| Locum tenens (orthopedic NP) | $145,000–$195,000 (annualized) | $70–$95/hr bill rate; no benefits, travel costs partially covered; high flexibility; income depends on booking consistency |
Hospital inpatient roles often come with robust benefits packages – pension, health insurance, malpractice coverage, and paid CME – that partially offset the salary gap with higher-earning private practice roles. VA positions carry federal benefits including FERS pension, TSP match, and 13 days of sick leave annually, which has significant long-term value.
Surgical first-assist is the single highest compensation lever within orthopedic NP practice. NPs who are authorized to function as surgical first-assists in the OR earn meaningfully more than those in outpatient-only roles. State practice law and individual hospital credentialing policies govern first-assist authorization – verify both before accepting a role that includes this as a primary function.
Salary by subspecialty
BLS does not publish subspecialty data, but compensation surveys and employer postings indicate meaningful variation across orthopedic subspecialties. These figures reflect general patterns from 2024–2025 employer data:
| Subspecialty | Estimated range | Notes |
|---|---|---|
| Spine surgery | $140,000–$175,000 | High surgical volume, complex pre/post-op management, often includes first-assist; premium reflects case complexity |
| Joint replacement (arthroplasty) | $135,000–$168,000 | High-volume programs generate strong RVU-based bonus potential; arthroplasty programs increasingly use NPs for full-episode co-management |
| Orthopedic trauma | $130,000–$162,000 | Call coverage requirements, inpatient complexity, and Level I trauma center employment often drive premiums; shift differentials and call pay significant |
| Sports medicine | $115,000–$150,000 | Wide range – professional sports team NP roles are at the high end; community outpatient sports medicine is lower; procedural volume matters |
| Hand and upper extremity | $120,000–$150,000 | Typically outpatient with injection volume; hand surgery practices tend to be smaller and may cap compensation potential vs. high-volume surgical practices |
| Pediatric orthopedics | $115,000–$145,000 | Children's hospital employment common; often on RN-to-NP pay scales at academic centers; non-surgical focus in most peds ortho NP roles |
Salary by state
The state-level figures below are BLS OEWS median annual wages for all NPs (SOC 29-1171, May 2025 release, retrieved via O*NET). Because BLS does not break out orthopedic specifically, these represent the baseline against which orthopedic specialty premiums apply – orthopedic NPs in high-volume surgical practices typically earn 5–15% above the state NP median.
| State | NP median annual salary (BLS OEWS, May 2025) |
|---|---|
| California | $168,520 |
| New Jersey | $159,310 |
| Washington | $156,100 |
| Oregon | $155,680 |
| New York | $153,510 |
| Massachusetts | $142,440 |
| Nevada | $140,670 |
| Hawaii | $135,570 |
| Arizona | $134,420 |
| Colorado | $132,930 |
| Texas | $131,670 |
| Michigan | $131,450 |
| Illinois | $130,680 |
| Pennsylvania | $130,140 |
| Florida | $129,510 |
| Georgia | $129,430 |
| North Carolina | $128,990 |
| Ohio | $124,870 |
| Tennessee | $117,590 |
| Alabama | $105,750 |
How to use this table: The figures above are BLS medians for all NPs in each state, not orthopedic-specific data. California’s figure ($168,520) reflects high cost of living, a large number of employed NPs in well-funded health systems, and a state that restricts non-compete agreements, all of which increase NP bargaining power. States in the South and lower Midwest have lower NP medians partly because of cost of living differences and partly because of state scope-of-practice regulations that historically limited NP autonomy.
Note how wide the within-state spread is compared with the spread between states. California’s NP 10th percentile ($120,340) sits below Texas’s median, while its 90th percentile reaches $240,830 – so where you land inside a state’s distribution matters more than which state you pick. For orthopedic NPs, that distribution is exactly what procedural scope moves you through. Check the current figure for your own state on the O*NET wage page for SOC 29-1171 before using any of these numbers in a negotiation, since OEWS publishes a new vintage each spring.
For orthopedic NPs specifically, the premium above the state median tends to be most pronounced in states with large orthopedic surgery volumes – California, Texas, Florida, New York, Pennsylvania – where high-volume arthroplasty and spine programs compete for qualified NPs.
Orthopedic NP salary vs. other surgical specialty NPs
Orthopedic NPs sit in the middle-to-upper tier of surgical specialty NP compensation. The comparison below draws on 2024–2025 specialty salary surveys and employer data:
| Specialty | Estimated average annual salary | Key comparison notes |
|---|---|---|
| Cardiovascular / cardiac surgery NP | $145,000–$165,000 | High-acuity inpatient focus, 24/7 call coverage in many roles, procedural premium for EP and cath lab NPs; consistently at the top of NP specialty compensation |
| Neurosurgery NP | $135,000–$160,000 | Spine overlap with orthopedic NP; complex post-operative management; academic medical center concentration; call requirements common |
| Orthopedic NP | $130,000–$165,000 | Wide range based on subspecialty and procedural scope; spine and arthroplasty at the upper end; outpatient community orthopedics at the lower end |
| General surgery NP | $125,000–$150,000 | Typically inpatient-focused, high volume, broad scope; academic medical center rates higher than community hospital rates; less subspecialty premium opportunity |
Cardiovascular surgery NPs consistently lead NP specialty compensation rankings. The gap between orthopedic and cardiovascular surgery NP pay reflects both the intensity of the cardiovascular role (higher acuity, more frequent call, more inpatient complexity) and the longer history of CV surgery programs in building formal NP/PA models. As orthopedic surgery increasingly adopts structured APP co-management programs for arthroplasty and spine surgery, the compensation gap is narrowing.
Career progression and salary trajectory
Orthopedic NP compensation grows with three variables: years of specialty experience, procedural scope, and organizational role.
Staff orthopedic NP (years 0–4): Starting salaries for new-graduate NPs entering orthopedic roles map roughly onto the national 10th-to-25th percentile band ($101,340–$117,990), with California, Washington, and New York markets starting well above that. Structured onboarding and close surgeon supervision characterize this phase. Base salary is the primary compensation component.
Experienced orthopedic NP (years 5–9): After establishing clinical independence and earning ONP-C certification, salary often moves into the median-to-75th-percentile band ($132,300–$156,700). Performance-based bonuses, RVU incentive structures, and expanding procedural scope drive the increase. NPs who develop surgical first-assist competency enter the upper salary band. Note that ONP-C eligibility is gated on experience, and on the right kind of experience. The Orthopaedic Nurses Certification Board requires three full years of practice as an RN or APRN, a master’s degree or higher from an NP program, and a minimum of 2,000 hours of advanced practice nursing experience within the past three years while currently practicing as an NP caring for patients with musculoskeletal conditions. The hours requirement counts NP-role hours specifically, so time logged as a staff RN builds the three-year threshold but does not accrue toward the 2,000. Plan the exam date around when the advanced practice hours will be complete.
Lead NP / APP program director (years 10+): Orthopedic surgery groups and academic centers with large NP/PA workforces increasingly hire lead NPs or Director of Orthopedic APP Practice positions. These roles combine a full clinical schedule with administrative responsibilities – onboarding new providers, managing clinical protocols, quality improvement – and typically carry $150,000–$180,000+ in total compensation. Academic program director roles at teaching hospitals can include faculty appointments with additional compensation.
Factors that meaningfully increase compensation
- Surgical first-assist authorization: The single largest individual salary lever. NPs who first-assist in orthopedic surgery earn 15–25% more than outpatient-only NPs in most market surveys
- ONP-C certification: Employers in competitive markets increasingly pay a $2,000–$5,000 premium for ONP-C holders, or require it for senior roles
- Subspecialty expertise: Spine and arthroplasty consistently pay more than general orthopedic outpatient work
- Procedural volume: Practices compensating via RVU models reward NPs who see more patients and perform more procedures
- Geographic demand: Rural and underserved orthopedic markets with recruitment challenges often offer sign-on bonuses ($10,000–$30,000) and relocation packages that effectively increase first-year compensation significantly
Benefits and total compensation
Base salary is only one component of orthopedic NP total compensation. In health system and hospital-employed roles, benefits packages routinely include:
- Medical, dental, and vision insurance (full family coverage in many academic systems)
- Malpractice insurance (employer-paid, with tail coverage in most health system roles)
- Retirement plan contributions (403(b) match in nonprofits, 401(k) in private practice)
- CME allowance: $2,000–$5,000 annually, with paid CME days
- Paid time off: 4–6 weeks annually in most health system roles
- Loan repayment programs (NHSC, state-specific programs, VA Education Debt Reduction Program)
VA orthopedic NP positions carry federal benefits – Federal Employees Retirement System (FERS) pension, Thrift Savings Plan with government match, and civil service job protections – that have substantial long-term value relative to private sector employment.
For context on general NP compensation, see the family nurse practitioner salary guide, which covers the BLS data structure and percentile distribution in more detail.
Frequently asked questions
What is the average orthopedic NP salary? The BLS national median for all NPs (OEWS, May 2025) is $132,300, and orthopedic NPs cluster modestly above it. Because no federal dataset isolates the specialty, published “average orthopedic NP salary” figures come from survey panels and job-board samples rather than a measured national population, so treat them as indicative. Orthopedic NPs in high-volume surgical practices typically earn above the all-NP median; outpatient community practice roles sit closer to or slightly below it.
Do orthopedic NPs earn more than FNPs? In most markets, yes – particularly in procedure-heavy and surgical co-management roles. FNPs in primary care settings generally earn closer to the national NP median ($132,300). Orthopedic NPs who first-assist in surgery, manage high-volume arthroplasty or spine programs, or work in procedure-intensive private practices earn meaningfully more. See the FNP salary guide for a direct comparison.
Which state pays orthopedic NPs the most? California has the highest NP median wage of any state at $168,520 (BLS OEWS, May 2025), and orthopedic NP salaries track above that in high-volume surgical markets like Los Angeles, San Francisco, and San Diego. New Jersey ($159,310), Washington ($156,100), Oregon ($155,680), and New York ($153,510) also sit at the upper end of state salary distributions.
Can orthopedic NPs earn over $200,000? Yes – primarily through locum tenens at high bill rates ($70–$95/hr, annualized to $145,000–$195,000 at full-time volume) or hybrid models combining W-2 employment with supplemental locum shifts. Experienced NPs in leadership roles at large orthopedic surgery programs can also approach or exceed $180,000 in total compensation when bonuses, procedural pay, and benefits are included.
How does ONP-C certification affect salary? ONP-C certification is not universally required, but competitive employers – particularly academic medical centers, large orthopedic surgery groups, and those hiring for lead NP roles – increasingly pay $2,000–$5,000 salary premiums for ONP-C holders or set the credential as a condition for promotion. The certification signals validated specialty competency beyond the primary NP license. See how to become an orthopedic NP for full certification requirements.
For specialty comparison, the oncology NP salary guide covers another high-demand NP specialty with its own distinct compensation structure. The family nurse practitioner salary guide provides the BLS NP data baseline in detail.
References
- US Bureau of Labor Statistics, “Occupational Employment and Wage Statistics: Nurse Practitioners (SOC 29-1171),” May 2025 estimates, released 15 May 2026.
- ONET OnLine, “Summary Report for 29-1171.00 – Nurse Practitioners,” National Center for ONET Development, 2026 (national median and percentile wage data, BLS May 2025 vintage).
- ONET OnLine, “Wages by State for 29-1171.00 – Nurse Practitioners,” National Center for ONET Development, 2026 (state-level median and percentile wage data).
- US Bureau of Labor Statistics, “Occupational Outlook Handbook: Nurse Anesthetists, Nurse Midwives, and Nurse Practitioners,” Employment Projections 2024–2034.
- Orthopaedic Nurses Certification Board, “ONP-C Certification: Advanced Practice Nurse Exam Eligibility,” ONCB, 2026. Three full years of RN or APRN practice; master’s degree or higher from an NP program; minimum 2,000 hours of advanced practice nursing experience within the past three years. Recertification: 1,500 NP-role hours across the five-year term and 100 contact hours, 65 of them in clinical orthopaedics.
- American Association of Nurse Practitioners, “NP Fact Sheet,” AANP, 2026.
- US Office of Personnel Management, “Fact Sheet: Sick Leave (General Information),” OPM Pay and Leave Administration.
- US Department of Veterans Affairs, “VA Handbook 5011: Hours of Duty and Leave,” Title 38 nurse leave accrual provisions.
- American Academy of Orthopaedic Surgeons, “Orthopaedic Practice in the US,” AAOS Department of Clinical Quality and Value (practice-setting and workforce context).