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Five orthopaedic surgery codes on BCBS, professional rates, TX — client rate against the market distribution for each code.
| Code | Client rate | Percentile | Min | Q1 | Median | Mean | Q3 | P95 | Medicare | Client % of Medicare |
|---|---|---|---|---|---|---|---|---|---|---|
| 27447Total knee arthroplasty | $1,627.52 | 52nd | $918.63 | $1,401.10 | $1,610.36 | $1,860.27 | $2,030.65 | $3,312.69 | $1,212.23 | 134% |
| 27130Total hip arthroplasty | $1,629.61 | 53rd | $919.80 | $1,410.92 | $1,610.41 | $1,868.76 | $2,075.93 | $3,540.45 | $1,215.27 | 134% |
| 29827Shoulder arthroscopy, rotator cuff repair | $1,359.19 | 59th | $725.09 | $1,057.06 | $1,239.66 | $1,426.34 | $1,573.14 | $2,531.03 | $1,016.11 | 134% |
| 29881Knee arthroscopy, meniscectomy | $696.55 | 58th | $365.95 | $549.75 | $641.92 | $749.53 | $824.51 | $1,444.17 | $533.44 | 131% |
| 20610Arthrocentesis, major joint | $82.05 | 73rd | $30.97 | $52.94 | $64.58 | $75.51 | $83.73 | $142.05 | $70.37 | 117% |
Source: BCBS negotiated-rate files, professional billing class, filtered to Orthopaedic Surgery taxonomies, TX. Medicare reference: Medicare, Houston locality, non-facility, CMS Physician Fee Schedule 2025.
The same query, one code at a time, across every payer in the market — CPT 27447, Total knee arthroplasty. Violet markers show where the client's contracted rate sits in each payer's distribution: 22nd on UHC and 18th on Cigna (the renewal priorities), 40th on Aetna, and 62nd on BCBS. Closing just the UHC gap to median is roughly $225.36 per case.
Orthopaedic Surgery, professional rates, TX · whiskers are Tukey bounds (1.5×IQR) · full figures in the table below
| Payer | Client rate | Percentile | Min | Q1 | Median | Mean | Q3 | P95 | Count | vs Median |
|---|---|---|---|---|---|---|---|---|---|---|
| UHC | $1,385.00 | 22nd | $918.63 | $1,401.10 | $1,610.36 | $1,860.27 | $2,030.65 | $3,312.69 | 811 | $-225.36 |
| Aetna | $1,285.00 | 40th | $1,062.00 | $1,176.00 | $1,333.36 | $1,548.99 | $1,665.74 | $2,676.29 | 640 | $-48.36 |
| Cigna | $1,295.00 | 18th | $350.00 | $1,442.37 | $1,555.60 | $1,926.94 | $2,229.78 | $3,372.43 | 796 | $-260.60 |
| BCBS | $1,695.00 | 62nd | $1,056.37 | $1,256.21 | $1,627.52 | $1,661.21 | $1,740.23 | $2,280.00 | — | +$67.48 |
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