Total joint replacement cases bring in $16,038 per visit at ambulatory surgery centers, the highest of any procedure category tracked, according to HST Pathways' analysis of 102 ASCs published June 3, 2025. Broader orthopedic cases average $6,419 per visit, more than four times what a gastroenterology case earns at $1,362.
The gap between specialties did not hold steady from one year to the next. Orthopedics grew 4.5% from $6,141 in 2023 to $6,419 in 2024. Cardiology fell 8.0% over the same period, from $5,014 to $4,611 per case, even as the centers running those cases became faster and more efficient.
Per-case revenue is one of the few ASC metrics a practice executive can compare directly against a proposed service line before committing capital. A practice deciding whether to affiliate with an ASC, add operating rooms, or shift a procedure from the hospital outpatient department to an ambulatory setting is, in effect, choosing which row of this table to bet on. The figures below come from HST Pathways, a perioperative software vendor whose platform processes scheduling and billing data for ASCs nationwide, giving it a direct view into case-level revenue that survey-based reports cannot match.
What Each Specialty Actually Earns Per Case
HST Pathways tracks case-level revenue through two overlapping 2025 studies: a flagship report covering 590 ASCs in 47 states and more than 3 million cases, and a narrower analysis of 102 ASCs and 1,097,844 cases. Both cover the same window, January 2023 through December 2024, and use slightly different specialty definitions, which is why cardiology and the broader cardiovascular category show different figures below.
| Specialty | 2024 net revenue/case | 2023 net revenue/case | Change |
|---|---|---|---|
| Total joints | $16,038 | $14,919 | +7.5% |
| Orthopedics (overall) | $6,419 | $6,141 | +4.5% |
| Cardiovascular (broad) | $4,733 | $4,849 | -2.4% |
| Cardiology (narrow) | $4,611 | $5,014 | -8.0% |
| Plastic surgery | $4,594 | n/a | n/a |
| Pain management | $3,722 | $3,201 | +16.3% |
| Podiatry | $3,256 | n/a | n/a |
| Otolaryngology (ENT) | $2,554 | n/a | n/a |
| Dental | $2,464 | n/a | n/a |
| Urology | $1,887 | $1,955 | -3.5% |
| Ophthalmology | $1,634 | $1,732 | -5.7% |
| Gastroenterology | $1,362 | $1,333 | +2.2% |
Source: HST Pathways, State of the ASC Industry Report and Where's the Money? Revenue Trends in Four ASC Specialties.
Total joints stand apart from the rest of the table. No other category reached even half of the $16,038 figure. Total joints are a subset of orthopedic procedures, mainly hip and knee replacement, so the two rows are not additive, but the comparison still shows what a joint program can add to a center that already runs general orthopedic cases. Every specialty outside orthopedics and cardiovascular care fell under $5,000 per case in 2024.
Four specialties in the table, plastic surgery at $4,594, podiatry at $3,256, otolaryngology at $2,554, and dental at $2,464, appear only in the 590-center flagship report, which did not publish a matching 2023 figure for those categories in the same format. That leaves seven specialties with a clean year-over-year comparison and four with a single data point. Both are still real, current figures from the same named source, not an estimate.
Why Cardiology's Case Value Is Falling While Efficiency Rises
Cardiology cases dropped 8.0% in net revenue per case between 2023 and 2024, but the centers running them moved faster. Average operating room time fell 27.7%, from 48 minutes to 34.7 minutes per case, according to HST Pathways. Revenue per OR minute still rose 27.2%, from $104 to $133, because centers pushed more cases through the same block time.
That split matters for a team judging whether cardiology block time still pays off. The per-case number alone points toward cutting it. The per-minute number points the other way: cardiology produced more revenue per unit of OR capacity in 2024 than it did a year earlier, even as payers reimbursed less for each individual case.
The same pattern likely applies wherever a specialty shows a falling case value alongside rising procedure volume, since a single per-case average can hide a shift toward shorter, lower-acuity cases rather than an actual drop in what any one procedure pays. Anyone comparing this year's per-case figure to last year's should ask for OR-minute or per-hour figures alongside it before changing block-time allocations.
The Billing Side Is Getting Slower, Not Faster
HST Pathways' data also tracked what happens after a case closes. Claim denial rates fell from 8.0% to 4.0% year over year, a real improvement. Other collection metrics moved the opposite way. Prior authorization completion before the date of service rose only to 24.0%, up from 21.0% in 2023, meaning about three in four cases still proceeded without a confirmed authorization on file.
Patient deposits collected at time of service fell from 55.0% to 51.0%. Days to bill after a case rose from 3.6 to 4.4. The payment mix shifted toward partial payments, which climbed from 41.2% to 56.2% of transactions, while full payments at time of service dropped from 25.8% to 17.0%. Centers billed slower and collected less complete payment even as their denial rates improved.
For a billing company managing several ASC clients, the two trends point in different directions and probably need different fixes. A falling denial rate suggests the front-end eligibility and coding checks are working. A rising share of partial payments and a slower billing cycle suggest the collections workflow after a claim is paid is where the remaining friction sits, not the claim submission itself.
What Center Size Means for Revenue Growth
Facility size shaped which centers captured revenue growth in 2024. Two-operating-room centers grew revenue 22.0% year over year, the strongest gain of any facility size in HST Pathways' data. Centers with 15 or more operating rooms saw revenue decline 8.0% over the same period.
HST Pathways also modeled the payoff from raising OR utilization. Raising utilization by 10% to 20% is worth an estimated $500,000 to $2,250,000 in additional annual net revenue per center, depending on case mix and current volume, according to the report. For a practice-affiliated ASC running under capacity, that is the dollar range attached to filling more of the existing schedule rather than adding rooms.
Sources
- HST Pathways, "A Comprehensive Look at ASC Data from 2024"
- HST Pathways, "Where's the Money? Revenue Trends in Four ASC Specialties," June 3, 2025
- Ambulatory Surgery Center News, "With an Average Net Revenue Per Case of $6,419, Orthopedics Again Proving Profitable for ASCs," October 2024
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