The national median salary for all nurse practitioners is $128,490 per year (Bureau of Labor Statistics, SOC 29-1171, May 2024). 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 $150,000–$175,000. Entry-level orthopedic NP roles in outpatient community practices sit closer to the $110,000–$125,000 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 over 1.1 million employers annually. The May 2024 data for SOC 29-1171 (Nurse Practitioners) — the classification covering all NP specialties — shows the following national figures:
| Metric | Value (BLS, May 2024) |
|---|---|
| National median annual salary | $128,490 |
| National mean annual salary | $132,050 |
| 25th percentile | ~$104,000 |
| 75th percentile | ~$158,000 |
| 90th percentile | ~$185,000+ |
| Median hourly rate | ~$61.77 |
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 (2024–2025) puts the average orthopedic NP compensation at approximately $134,000–$140,000 annually 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.
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 2024 data). 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 May 2024) |
|---|---|
| California | $149,910 |
| New Jersey | $129,240 |
| New York | $128,220 |
| Massachusetts | $128,160 |
| Washington | $128,980 |
| Hawaii | $131,000 |
| Minnesota | $127,690 |
| Oregon | $127,690 |
| Nevada | $127,620 |
| Rhode Island | $125,540 |
| Connecticut | $125,360 |
| Alaska | $123,140 |
| Montana | $122,100 |
| Illinois | $122,960 |
| Arizona | $121,070 |
| Delaware | $121,470 |
| Iowa | $121,470 |
| Texas | $121,010 |
| New Hampshire | $121,070 |
| New Mexico | $121,070 |
| Wisconsin | $121,310 |
| Maine | $119,550 |
| Oklahoma | $109,660 |
| Pennsylvania | $106,700 |
| Utah | $105,220 |
| Maryland | $104,550 |
| Indiana | $104,020 |
| Louisiana | $103,610 |
| North Dakota | $103,550 |
| Nebraska | $103,340 |
| Ohio | $103,310 |
| Virginia | $102,860 |
| Idaho | $102,060 |
| Michigan | $102,060 |
| South Dakota | $102,060 |
| Arizona | $121,070 |
| Colorado | $102,370 |
| North Carolina | $102,370 |
| Wyoming | $102,370 |
| District of Columbia | $121,470 |
| Georgia | $101,690 |
| Mississippi | $101,840 |
| Florida | $101,110 |
| Missouri | $101,180 |
| Vermont | $101,790 |
| Kansas | $100,590 |
| Kentucky | $100,260 |
| West Virginia | $100,020 |
| South Carolina | $100,020 |
| Arkansas | $99,910 |
| Alabama | $99,750 |
| Tennessee | $99,630 |
How to use this table: The figures above are BLS medians for all NPs in each state, not orthopedic-specific data. California’s figure ($149,910) reflects a combination of high cost of living, a large number of employed NPs in well-funded health systems, and a state that restricts non-compete agreements — increasing NP bargaining power. States in the South and lower Midwest have lower NP medians partly due to cost of living differences and partly due to state scope-of-practice regulations that historically limited NP autonomy.
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 typically run $105,000–$120,000 in most US markets, with California, Washington, and New York markets starting higher. 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 ONP-C certification (typically around the 2–3 year mark for full-time NPs), salary often moves to $130,000–$155,000. 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.
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? Industry salary survey data puts the average orthopedic NP salary at approximately $134,000–$140,000 annually for W-2 employment in 2024–2025. The BLS national median for all NPs (May 2024) is $128,490. Orthopedic NPs in high-volume surgical practices typically earn above this figure; outpatient community practice roles sit closer to or slightly below the national median.
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 ($128,490). 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 $149,910 (BLS May 2024), and orthopedic NP salaries track above that in high-volume surgical markets like Los Angeles, San Francisco, and San Diego. New Jersey, Washington, New York, and Hawaii 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.