UnitedHealthcare · California · commercial in-network

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

Across 228 procedure codes for 8 specialties
Rate index vs state market
126
26% above the California median
Rank in state
1 of 4
UHC 126 · Cigna 112 · BCBS 96 · Aetna 84
vs own national
96
UHC's level vs its national median
Codes where highest
58%
of 228 codes
658 sampled providers615 TINs228 codesMedian 176% of Medicare · method

What the data shows

Generated from California and UnitedHealthcare data only
1

UnitedHealthcare ranks 1st of 4 payers in California with a rate index of 126 (100 = the California market median), across 228 procedure codes.

2

UnitedHealthcare has the highest median for 58% of codes in California.

3

UnitedHealthcare's California rates sit 4% below its own national level, the 30th highest of its 51 states.

4

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

Rate index: 100 = the state four-payer median for the same codes
PayerIndexRankLevelHighest onProviders
UnitedHealthcare1261
126
58%658
Cigna1122
112
34%648
Blue Cross Blue Shield963
96
6%807
Aetna844
84
2%566

Where UnitedHealthcare pays most and least against the California market

Codes with the largest gap to the state median

Highest above market

CodeUHCMarketGapProv.
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

CodeUHCMarketGapProv.
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

Index vs the payer's own national median (100 = national)

Highest states

StateIndexProv.
Alaska193
164
Wisconsin173
610
Minnesota166
618
Oregon164
683
Massachusetts152
772

Lowest states

StateIndexProv.
Alabama73
719
Florida78
744
Arizona82
699
Louisiana83
808
Delaware83
379

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

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.

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