BackgroundExtensive evidence documents geographic variation in spending, but limited research assesses geographic variation in quality, particularly among commercially insured enrollees. ObjectiveTo measure geographic variation in quality measures, correlation among measures, and correlation between measures and spending for commercially insured enrollees. Data SourceAdministrative claims from the 2007-2009 Truven MarketScan database. MethodsWe calculated variation in, and correlations among, 10 quality measures across 306 Hospital Referral Regions (HRRs), adjusting for beneficiary traits and sample size differences. Further, we created a quality index and correlated it with spending. ResultsThe coefficient of variation of HRR-level performance ranged from 0.04 to 0.38. Correlations among quality measures generally ranged from 0.2 to 0.5. Quality was modestly positively related to spending. ConclusionQuality varied across HRRs and there was only a modest geographic quality footprint.