Same doctor, same visit, different price
Four insurers post their prices for the same Texas doctors. For the same doctor and the same office visit, the highest posted rate is a median 1.45 times the lowest. Same doctor, same visit. Only the insurer changes. Inside one insurer, BCBSTX, the same doctors have a median posted rate of 77% of Medicare in one network and 95% in another.
What this page compares. The price each insurer posts for a doctor's office visit, in the federal Transparency in Coverage files. Each rate is shown as a percent of what Medicare pays for the same visit in Dallas in 2026, so 100% means the Medicare price. The doctors are the Texas clinicians in the Cost Plus Wellness network, and each one is counted only for a visit code they billed to Medicare in 2024. This is about how insurers price the same work. It is not a judgment of any doctor: an insurer and a doctor agree a rate for each network, and the insurer posts it.
Four insurers, one doctor
Each row is one office visit code. Each cell is the median posted rate, as a percent of Medicare, for the doctors that insurer lists, with the number of doctors under it. The last column compares insurers inside each doctor: for every doctor with rates from two or more insurers, it takes the highest rate over the lowest, then the median across doctors.
| Visit code | Medicare, Dallas 2026 | BCBSTX | United | Cigna | Aetna | Highest over lowest, same doctorHigh over low |
|---|---|---|---|---|---|---|
| 99203 New patient, low complexity | $117.06 | 107% n 789 | 139% n 617 | 139% n 601 | 98% n 409 | 1.47x 641 pairs |
| 99204 New patient, moderate complexity | $176.67 | 109% n 1,609 | 157% n 1,410 | 138% n 1,372 | 115% n 869 | 1.45x 1,439 pairs |
| 99205 New patient, high complexity | $235.73 | 105% n 601 | 149% n 593 | 136% n 592 | 94% n 321 | 1.43x 595 pairs |
| 99213 Established patient, low complexity | $94.96 | 98% n 2,666 | 117% n 2,385 | 126% n 2,344 | 84% n 1,436 | 1.46x 2,427 pairs |
| 99214 Established patient, moderate complexity | $135.25 | 95% n 3,154 | 119% n 2,846 | 134% n 2,819 | 98% n 1,698 | 1.46x 2,900 pairs |
| 99215 Established patient, high complexity | $191.87 | 95% n 1,270 | 116% n 1,244 | 137% n 1,231 | 94% n 674 | 1.44x 1,252 pairs |
Navy: the lowest insurer median in the row. Orange: the highest. Office setting (place of service 11), non-facility Medicare price. Across the six codes, 9,254 doctor and visit pairs have two or more insurers; the median highest over lowest is 1.45x and the 90th percentile is 1.81x.
One insurer, seven price lists
BCBSTX posts a separate file for each network and for each self-insured employer plan it runs. The same doctor often has a different rate in each. For the same doctor and visit code, the highest rate in any BCBSTX file is a median 1.48 times the lowest (10,089 doctor and visit pairs). Network by network, the highest network median for the pair is 1.43 times the lowest. The bars show the median rate in each Texas network, across the doctors that network lists. The dashed line is the Medicare price.
Six BCBSTX Texas networks and the self-insured employer plan files (102%). Office visits 99203 to 99205 and 99213 to 99215 pooled. Each doctor and visit pair counts once per network, at the median of that network's files. Networks list different doctors. Across the doctors each network lists, the medians run from 77% to 105% (the bars). On the 2,883 doctor and visit pairs that all seven list, they run from 77% to 95%, the range in the lede.
Method
The files
Since 2022, federal Transparency in Coverage rules require each insurer to post machine-readable files of its in-network rates. Each file lists the price for each billing code and each provider in one network or plan. We read the files from BCBSTX, UnitedHealthcare, Cigna and Aetna, posted in October and November 2026, and kept the rows for the clinicians in Cost Plus Wellness contracts in Texas. "Doctor" on this page means any clinician with an NPI, which includes nurse practitioners and physician assistants. A rate is linked to a clinician through their NPI or their group's tax ID.
Rates with no visits behind them
Insurer files list many rates for clinicians who do not bill that code. We kept a doctor and code pair only when that clinician billed the code to Medicare in Texas in 2024 (CMS Medicare Physician and Other Practitioners, by Provider and Service). About 12% of the posted pairs have such a claim, in any setting: BCBSTX 11,892 of 98,562; UnitedHealthcare 10,825 of 89,009; Cigna 10,682 of 86,339; Aetna 11,093 of 88,367. An office rate then also needs an office claim for that code. This is a cleaning step. It means every rate on this page belongs to a clinician who does this visit.
Modifiers, place of service and percent of charge
Only rates with no modifier are kept. Rows dropped for a modifier (rows times clinicians, all nine codes pulled): BCBSTX 370, UnitedHealthcare 8,172, Cigna 0, Aetna 335,419. Only professional rates are kept; BCBSTX also listed 12,656 institutional rows. A rate counts as office when its place of service list includes 11. A rate with no place of service fills the office slot only when no office rate exists. Rates posted only for other places of service are dropped: BCBSTX 655, UnitedHealthcare 447,024, Aetna 241. Rates posted as a percent of billed charges have no dollar value and are left out: BCBSTX 5,645, UnitedHealthcare 0, Cigna 286, Aetna 131,816.
Duplicate plans
The same doctor and code often appear in many files. Each file gives one rate for the pair, its median, and the pair takes the median across files. Pairs with two or more different rates (office and facility settings): BCBSTX 11,991 of 12,203; UnitedHealthcare 1,729 of 11,135; Cigna 4,042 of 10,989; Aetna 1,482 of 7,236. Using each pair's lowest, chosen and highest plan rate gives these office visit medians (percent of Medicare): BCBSTX 68%, 98%, 117%; UnitedHealthcare 122%, 129%, 133%; Cigna 120%, 136%, 138%; Aetna 80%, 96%, 112%.
Out-of-state Blue networks
The BCBSTX index also lists other Blue plans' networks that BCBSTX members can use outside Texas. They are dropped: 538 of 960 files, 68 network labels and 5,622 rows in these codes. The six BCBSTX Texas networks and the self-insured employer files stay.
Benchmark
CMS 2026 Medicare Physician Fee Schedule, RVU26D (October 2026), conversion factor 33.4009, Dallas locality (MAC 04412, locality 11), non-facility price. 100% means this price.
What this can and cannot say
These are posted rates, not paid claims. How much a patient pays depends on their plan's deductible and coinsurance. The clinicians are the Cost Plus Wellness network in Texas, not all Texas doctors, and about 61% of the insurer rates on this page belong to one health system's clinicians. The page names no doctor, group or health system, and every cell rests on 11 or more clinicians.