UnitedHealthcare · payer overview

UnitedHealthcare negotiated rates by state and specialty

Where UnitedHealthcare pays above and below the market, from its published in-network files.

UnitedHealthcare at a glance

228 codes · 51 states · 31,635 sampled providers · source: UnitedHealthcare Choice plans
Rate index
113
100 = four-payer median
Payer rank
1 of 4
1 = highest
Median % of Medicare
167%
across tracked codes
Highest on
69%
of codes

What the data shows

1

UnitedHealthcare ranks 1st of 4 payers with a rate index of 113 (100 = four-payer median) across 228 procedure codes.

2

Its median rate is 167% of Medicare, and it has the highest median on 69% of codes in the files analyzed.

3

Strongest market: District of Columbia (index 142 vs that state's market); weakest: Mississippi (90).

4

Largest premium over the market: CPT 64566 (Neuroeltrd stim post tibial) at 215% of market.

5

By specialty it is strongest for gastroenterology (ranks 1st of 4 payers).

UnitedHealthcare by state

Index vs the state market; own-national index vs the payer's national level
StateIndex vs marketRank in statevs own nationalLevelProviders
District of Columbia1421 of 4132
396
Vermont1421 of 4126
279
Minnesota1411 of 4166
618
New Hampshire1391 of 4144
629
Massachusetts1371 of 4152
772
Illinois1331 of 4111
706
New Mexico1321 of 4109
471
Maryland1311 of 495
606
West Virginia1301 of 4103
512
Rhode Island1291 of 4104
468
New York1281 of 4101
801
Connecticut1271 of 4135
804
California1261 of 496
658
Wisconsin1251 of 4173
610
Texas1241 of 488
824
Maine1241 of 4114
546
Oregon1211 of 4164
683
Oklahoma1201 of 484
728
Iowa1181 of 4132
605
Indiana1171 of 489
805
Nebraska1161 of 4139
556
Virginia1161 of 493
733
Georgia1151 of 4125
780
Arizona1151 of 482
699
Pennsylvania1151 of 496
751
Ohio1151 of 498
802
Kentucky1141 of 488
820
Montana1142 of 4100
323
Alaska1142 of 4193
164
Colorado1131 of 4105
749
Missouri1121 of 493
821
Florida1121 of 478
744
Tennessee1121 of 496
775
South Carolina1112 of 489
733
Arkansas1111 of 491
680
North Carolina1111 of 4112
747
Utah1111 of 495
649
Nevada1101 of 484
629
New Jersey1091 of 497
724
Delaware1081 of 483
379
Washington1061 of 4128
695
Louisiana1061 of 483
808
Michigan1062 of 484
664
South Dakota1041 of 4122
316
North Dakota1022 of 4120
210
Kansas1021 of 488
640
Hawaii1002 of 488
453
Idaho983 of 498
546
Alabama963 of 473
719
Wyoming932 of 4110
129
Mississippi903 of 486
676

UnitedHealthcare by specialty

Index vs the four-payer median for the specialty's codes
SpecialtyIndexRank of 4Highest onProviders
Gastroenterology1161 of 489%3,767
Internal medicine1191 of 488%4,253
Urology1211 of 481%3,590
Orthopedic surgery1101 of 467%4,265
Dermatology1191 of 484%3,646
Cardiology1141 of 482%4,303
Ophthalmology1071 of 455%3,838
Diagnostic radiology1141 of 463%3,973

Where UnitedHealthcare pays most and least against the market

Highest above market

CodeUHCvs market
64566
Neuroeltrd stim post tibial
$149+115%
52224
Cystoscopy and treatment
$966+111%
52332
Cystoscopy and treatment
$691+92%
52648
Laser surgery of prostate
$2,820+87%
11104
Punch bx skin single lesion
$149+84%
11102
Tangntl bx skin single les
$119+83%
43255
Egd control bleeding any
$822+79%
43251
Egd remove lesion snare
$756+78%

Furthest below market

CodeUHCvs market
92235
Fluorescein angrph mltiframe
$128-12%
88342
Imhchem/imcytchm 1st antb
$86-10%
76512
Oph us dx b-scan
$65-8%
93297
Rem interrog dev eval icpms
$48-8%
88312
Special stains group 1
$91-6%
93298
Rem interrog dev eval scrms
$49-6%
88305
Tissue exam by pathologist
$67-5%
88313
Special stains group 2
$67-5%

Methodology

How these numbers are calculated
  • 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.

Is your UnitedHealthcare contract at market?

Compare your negotiated rates with these medians by state and specialty.

Request a rate benchmark