Commercial healthcare reimbursement in Texas
How Texas compares with the nation, by payer, specialty and procedure.
Texas at a glance
What the data shows
Texas ranks 50th of 51 states for commercial reimbursement, with an index of 78 (100 = national median) across 228 procedure codes; the South region averages 94.
Commercial rates in Texas run a median 114% of Medicare.
UnitedHealthcare has the highest index in the state (124) and Blue Cross Blue Shield the lowest (88), a 37-point gap, in the files analyzed.
CPT 96910 (Photchmtx tar&uvb/ptrltm&uvb) comes closest to the national median (100% of it); CPT 72148 (Mri lumbar spine w/o dye) is furthest below (59% of the national median, 41% lower).
By specialty, Texas is strongest for dermatology (ranks 39th of 50 states for that specialty) and weakest for orthopedic surgery (51st of 51).
Against Medicare, gastroenterology has the highest ratio in Texas (140% of Medicare) and dermatology the lowest (90%).
Payer ranking in Texas
| Payer | Index | Rank | Level | Codes | Providers | TINs |
|---|---|---|---|---|---|---|
| UnitedHealthcare | 124 | 1 | 228 | 824 | 654 | |
| Cigna | 108 | 2 | 227 | 822 | 651 | |
| Aetna | 95 | 3 | 228 | 764 | 664 | |
| Blue Cross Blue Shield | 88 | 4 | 228 | 1,003 | 895 |
Reimbursement index by specialty in Texas
| Specialty | Index | Rank among states | % of Medicare | Level | Codes | Providers |
|---|---|---|---|---|---|---|
| Dermatology | 90 | 39 of 50 | 90% | 44 | 134 | |
| Ophthalmology | 86 | 43 of 50 | 102% | 42 | 123 | |
| Internal medicine | 80 | 46 of 51 | 92% | 25 | 122 | |
| Cardiology | 80 | 48 of 51 | 111% | 38 | 131 | |
| Urology | 80 | 49 of 50 | 126% | 37 | 124 | |
| Gastroenterology | 76 | 49 of 50 | 140% | 36 | 132 | |
| Diagnostic radiology | 75 | 50 of 51 | 115% | 49 | 133 | |
| Orthopedic surgery | 75 | 51 of 51 | 108% | 39 | 122 |
Specialty by payer in Texas
| Specialty | UHC | Aetna | Cigna | BCBS |
|---|---|---|---|---|
| Internal medicine | 102 | 71 | 92 | 68 |
| Dermatology | 112 | 78 | 92 | 92 |
| Ophthalmology | 98 | 86 | 86 | 82 |
| Cardiology | 99 | 74 | 90 | 69 |
| Orthopedic surgery | 91 | 67 | 82 | 67 |
| Diagnostic radiology | 118 | 81 | 105 | 34 |
| Urology | 101 | 80 | 88 | 67 |
| Gastroenterology | 98 | 70 | 85 | 66 |
Texas compared with South region states
Procedures that pay most and least in Texas vs the nation
Highest vs national
| Code | Texas | National | Gap | Prov. |
|---|---|---|---|---|
| 96910 Photchmtx tar&uvb/ptrltm&uvb | $125 | $125 | +0% | 134 |
| 93297 Rem interrog dev eval icpms | $52 | $52 | -0% | 130 |
| 92014 Compre oph exam est pt 1/> | $99 | $101 | -2% | 123 |
| 93298 Rem interrog dev eval scrms | $51 | $52 | -2% | 130 |
| 11603 Exc tr-ext mal+marg 2.1-3 cm | $260 | $267 | -3% | 134 |
| 17111 Destruction b9 lesions 15/> | $116 | $120 | -3% | 134 |
| 17000 Destruct premalg lesion | $67 | $69 | -3% | 134 |
| 92202 Opscpy extnd on/mac draw | $16 | $17 | -4% | 122 |
| 92004 Compre oph exam new pt 1/> | $120 | $124 | -4% | 123 |
| 92201 Opscpy extnd rta draw uni/bi | $26 | $27 | -4% | 122 |
| 14040 Tis trnfr f/c/c/m/n/a/g/h/f | $769 | $800 | -4% | 134 |
| 17282 Dstr mal ls f/e/e/n/l/m1.1-2 | $187 | $195 | -4% | 134 |
| 11602 Exc tr-ext mal+marg 1.1-2 cm | $218 | $228 | -4% | 134 |
| 96574 Dbrdmt prmlg les w/pdt | $301 | $315 | -5% | 134 |
| 12052 Intmd rpr face/mm 2.6-5.0 cm | $275 | $289 | -5% | 134 |
Lowest vs national
| Code | Texas | National | Gap | Prov. |
|---|---|---|---|---|
| 72148 Mri lumbar spine w/o dye | $225 | $382 | -41% | 255 |
| 73221 Mri joint upr extrem w/o dye | $238 | $399 | -40% | 255 |
| 73721 Mri jnt of lwr extre w/o dye | $238 | $399 | -40% | 255 |
| 88305 Tissue exam by pathologist | $43 | $70 | -39% | 266 |
| 88312 Special stains group 1 | $61 | $97 | -38% | 266 |
| 88313 Special stains group 2 | $45 | $71 | -37% | 132 |
| 76512 Oph us dx b-scan | $45 | $70 | -36% | 122 |
| 73562 X-ray exam of knee 3 | $34 | $53 | -35% | 122 |
| 77080 Dxa bone density axial | $43 | $66 | -35% | 133 |
| 73630 X-ray exam of foot | $29 | $44 | -35% | 122 |
| 72100 X-ray exam l-s spine 2/3 vws | $35 | $53 | -35% | 122 |
| 72110 X-ray exam l-2 spine 4/>vws | $46 | $71 | -35% | 122 |
| 73564 X-ray exam knee 4 or more | $39 | $60 | -34% | 122 |
| 73610 X-ray exam of ankle | $31 | $47 | -34% | 122 |
| 92250 Fundus photography w/i&r | $35 | $53 | -34% | 123 |
Frequently asked questions
How do commercial reimbursement rates in Texas compare with the rest of the country?
Texas ranks 50th of 51 states with an index of 78, across 228 procedure codes. Median commercial rates run 114% of the Medicare rate.
Which payer has the highest rates in Texas?
In the files we analyzed, UnitedHealthcare has the highest index (124) and Blue Cross Blue Shield the lowest (88). Each payer's figures describe the specific plans and networks in the files used, not its whole book of business.
Which specialty has the strongest rates in Texas?
Dermatology ranks 39th of 50 states.
How many providers does this Texas page cover?
1,021 sampled providers across 4 payers. The data comes from a random sample of providers, so counts describe the sample, not every provider in the state.
Which procedures differ most between Texas and the national median?
CPT 96910 (Photchmtx tar&uvb/ptrltm&uvb) is highest relative to the nation at 100% of the national median; CPT 72148 (Mri lumbar spine w/o dye) is lowest at 59%.
Methodology
- Source: in-network negotiated-rate files published under the federal Transparency in Coverage rule, August 2026 snapshot: UnitedHealthcare Choice plans (74 files); Aetna commercial plans (70 files); Cigna national PPO (1 files); BCBS licensees' own-network files (5,387 files). Payer comparisons describe these files, not each payer's entire book of business.
- Sample: rates come from a random sample of up to 150 providers per state and specialty. Counts on this page are sampled providers and TINs, not totals.
- Which providers count: only providers in a specialty relevant to the code, because a rate in a payer file attaches to a provider group and is listed under every provider in that group.
- Filters: fee-for-service, professional billing class, no modifier, negotiated or fee-schedule dollar rates. Rates outside 1% to 1,000% of the Medicare rate are excluded.
- Statistic: one median rate per provider, then percentiles across providers. A cell is shown only with at least 15 sampled providers and 4 TINs.
- Medicare benchmark: CY2026 national physician fee schedule, non-QPP conversion factor, unadjusted for locality. Where the non-facility rate is more than twice the facility rate (office rates that include device or supply cost), the facility rate is used so comparisons are like for like.
Benchmark your Texas contracts
Compare your negotiated rates with these state medians by payer and specialty.