What EBITDA multiple does an orthopedic practice sell for?

No public index reports orthopedic transaction multiples, so the published figures come from the valuation and M&A firms that work on the deals. Two 2026 sources opened for this answer, and they agree on the shape of the market but not on the top end. Stout, a valuation and advisory firm, wrote in its January 29, 2026 orthopedic outlook that it observes midsized orthopedic practice transactions with EBITDA multiples "ranging from the high single digits to low double digits," that "larger platform acquisition multiples are typically in the mid-teens range," and that smaller tuck-in acquisitions sit in the mid-single digits. Stout adds that orthopedic multiples tend to run higher than many other specialties because of ancillaries and the room for post-transaction income repair.

CT Acquisitions, an M&A adviser, publishes a numeric ladder in its June 6, 2026 guide. A single-surgeon practice with $500K to $1.5M of EBITDA goes 5x to 7x; a multi-surgeon single site or two-to-three-location practice with $1.5M to $5M goes 6x to 9x; a small regional group with ASC ownership (5 to 15 providers, $3M to $10M) goes 7x to 10x; a mid-size platform with $10M to $30M, integrated ASC, PT and imaging goes 9x to 12x; and a $30M-plus multi-state platform reaches 10x to 13x+. The two sources diverge at the top: Stout places large platforms in the mid-teens, CT Acquisitions caps its ladder near 13x. Treat the upper end as a range of opinion, not a fixed number.

The ASC is the biggest lever, and the two sources describe it differently. CT Acquisitions says the same practice with an owned ASC trades 2x to 3x EBITDA higher. Stout frames it through earnings: it reports orthopedic-focused ASCs with EBITDA margins above 50 percent, notes that ancillaries let selling surgeons repair their income after the deal, and says growing ancillary services "reduces the effective multiple paid by the acquirer through EBITDA growth." Either way, a group that owns the surgery center where its joints are done has more for a buyer to pay for. CT Acquisitions also flags Medicare above 60 percent of the payer mix as a factor that compresses the multiple.

The buyer type changes how the money arrives. In a private equity deal, Stout says rollover equity typically runs 20 to 40 percent of total purchase consideration, 30 to 35 percent on its recent orthopedic deals, and because practices distribute their earnings, EBITDA has to be created by cutting the sellers' cash compensation (the scrape). In Stout's worked example of a hospital deal, one third of the value is paid at closing and two-thirds is earned over the employment term, through compensation that must stay within fair market value. Worked example on the CT Acquisitions ladder: a two-location group with $2M of adjusted EBITDA sits in the 6x to 9x tier, so $12M to $18M of enterprise value. At 7.5x ($15M) and a 30 percent rollover, about $10.5M is paid at close and $4.5M rides on the platform's exit. Work out your adjusted EBITDA first, because the scrape and the add-backs move the result more than a turn of multiple does, and if a sale is one to three years out, getting ASC economics and a management layer a buyer believes in is the work fractional CFO support is for.