A standing snapshot of the DFW market, built from the five major commercial insurers' public in-network files. These are market statistics only — no practice-specific data appears here.
Median disclosed professional rate for the highest-volume ENT procedures, by insurer. The distance between the columns is money left on the table for a practice anchored to the wrong insurer.
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| CPT | Procedure | Cigna | UHC | BCBSTX | Aetna | BSW | Medicare |
|---|---|---|---|---|---|---|---|
| 30520 | Septoplasty | $749 | $832 | $846 | $982 | $753 | $609 |
| 31255 | Ethmoidectomy, total (FESS) | $481 | $437 | $404 | $468 | $359 | $271 |
| 42820 | Tonsillectomy and adenoidectomy, under age 12 | $353 | $344 | $372 | $431 | $331 | $259 |
| 31231 | Nasal endoscopy, diagnostic | $235 | $247 | $238 | $277 | — | $192 |
| 31237 | Nasal/sinus endoscopy, surgical (biopsy/debridement) | $396 | $325 | $333 | $387 | $285 | $265 |
| 99214 | Office visit, established patient, moderate complexity | $121 | $121 | $123 | $106 | $168 | $135 |
Median of unique tax-ID × rate observations per code and insurer, restricted to otolaryngology-taxonomy NPIs practicing in DFW counties. Surgical rates are the facility-setting professional fee (ASC / hospital outpatient); exams and injections are the office fee (POS 11). Medicare is the final CY2026 Physician Fee Schedule, Dallas locality, matched to setting. Figures rounded; individual practice rates vary around each median — see below. An em dash means that insurer does not publish the code in a directly comparable form.
The insurer spread is only half the story. On a single insurer, the gap between a practice at the 10th percentile and one at the 90th reaches 1.5× on high-volume surgical codes. Two ENT groups a few miles apart, same insurer, can be paid very differently for an identical procedure.
This is the number a practice can move. A group sitting near an insurer's floor, holding documented evidence of the disclosed median, has a concrete, data-backed case for parity at renewal.
| 10th percentile group | $720 |
| Median group | $753 |
| 90th percentile group | $1,052 |
A practice at the low end earns roughly 32% less than one at the high end for the same procedure, with the same insurer, in the same city.
Three independent public sources, each doing a specific job. Nothing here touches claims data or any patient-level information.
The Transparency-in-Coverage disclosures — negotiated professional rates by tax ID and NPI, per code. The primary source, published monthly by each insurer.
2026 hospital files add what insurers actually paid, drawn from remittance data, with claim counts — a cross-check on the negotiated rates and their real volume.
The CY2026 Physician Fee Schedule at the Dallas locality — the neutral yardstick every insurer contract is quoted against.