UnitedHealthcare negotiated rates in California
How UnitedHealthcare's California rates compare with the other three national payers, across the procedures that matter most to high-revenue specialties.
UnitedHealthcare in California at a glance
What the data shows
UnitedHealthcare ranks 1st of 4 payers in California with a rate index of 126 (100 = the California market median), across 228 procedure codes.
UnitedHealthcare has the highest median for 58% of codes in California.
UnitedHealthcare's California rates sit 4% below its own national level, the 30th highest of its 51 states.
Largest premium over the California market: CPT 52281 (Cystoscopy and treatment) at 204% of market; largest discount: CPT 76512 (Oph us dx b-scan) at 60%.
How the four payers compare in California
| Payer | Index | Rank | Level | Highest on | Providers |
|---|---|---|---|---|---|
| UnitedHealthcare | 126 | 1 | 58% | 658 | |
| Cigna | 112 | 2 | 34% | 648 | |
| Blue Cross Blue Shield | 96 | 3 | 6% | 807 | |
| Aetna | 84 | 4 | 2% | 566 |
Where UnitedHealthcare pays most and least against the California market
Highest above market
| Code | UHC | Market | Gap | Prov. |
|---|---|---|---|---|
| 52281 Cystoscopy and treatment | $621 | $304 | +104% | 64 |
| 52310 Cystoscopy and treatment | $595 | $292 | +104% | 71 |
| 52287 Cystoscopy chemodenervation | $668 | $329 | +103% | 64 |
| 51728 Cystometrogram w/vp | $915 | $476 | +92% | 80 |
| 51729 Cystometrogram w/vp&up | $974 | $508 | +92% | 80 |
| 43251 Egd remove lesion snare | $692 | $362 | +91% | 69 |
| 43255 Egd control bleeding any | $736 | $387 | +90% | 69 |
| 43248 Egd guide wire insertion | $579 | $310 | +87% | 69 |
Furthest below market
| Code | UHC | Market | Gap | Prov. |
|---|---|---|---|---|
| 76512 Oph us dx b-scan | $54 | $90 | -40% | 90 |
| 88342 Imhchem/imcytchm 1st antb | $64 | $100 | -36% | 74 |
| 65778 Cover eye w/membrane | $56 | $82 | -32% | 76 |
| 92250 Fundus photography w/i&r | $50 | $72 | -31% | 88 |
| 88305 Tissue exam by pathologist | $71 | $100 | -28% | 149 |
| 92136 Ophthalmic biometry | $64 | $85 | -25% | 88 |
| 92133 Cptrzd oph dx img pst sgm on | $38 | $49 | -23% | 84 |
| 92134 Cptrz oph dx img pst sgm rta | $39 | $50 | -23% | 84 |
Where UnitedHealthcare pays above and below its national level
Frequently asked questions
Does UnitedHealthcare pay more or less than the other payers in California?
UnitedHealthcare ranks 1st of 4 in California with an index of 126. It is highest on 58% of codes.
Are UnitedHealthcare's California rates above or below its national level?
About 4% below.
Which procedure does UnitedHealthcare pay most above market in California?
CPT 52281 (Cystoscopy and treatment), at 204% of the California median.
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.
Is your UnitedHealthcare contract at market in California?
Compare your negotiated rates for these codes with California medians for each payer.