UnitedHealthcare negotiated rates in Massachusetts
How UnitedHealthcare's Massachusetts rates compare with the other three national payers, across the procedures that matter most to high-revenue specialties.
UnitedHealthcare in Massachusetts at a glance
What the data shows
UnitedHealthcare ranks 1st of 4 payers in Massachusetts with a rate index of 137 (100 = the Massachusetts market median), across 228 procedure codes.
UnitedHealthcare has the highest median for 80% of codes in Massachusetts.
UnitedHealthcare's Massachusetts rates sit 52% above its own national level, the 5th highest of its 51 states.
Largest premium over the Massachusetts market: CPT 45385 (Colonoscopy w/lesion removal) at 214% of market; largest discount: CPT 93298 (Rem interrog dev eval scrms) at 82%.
How the four payers compare in Massachusetts
| Payer | Index | Rank | Level | Highest on | Providers |
|---|---|---|---|---|---|
| UnitedHealthcare | 137 | 1 | 80% | 772 | |
| Cigna | 109 | 2 | 14% | 808 | |
| Blue Cross Blue Shield | 98 | 3 | 5% | 837 | |
| Aetna | 62 | 4 | 0% | 595 |
Where UnitedHealthcare pays most and least against the Massachusetts market
Highest above market
| Code | UHC | Market | Gap | Prov. |
|---|---|---|---|---|
| 45385 Colonoscopy w/lesion removal | $1,369 | $640 | +114% | 203 |
| 99457 Rpm tx mgmt 1st 20 min | $138 | $65 | +113% | 196 |
| 45378 Diagnostic colonoscopy | $1,016 | $483 | +110% | 100 |
| 64566 Neuroeltrd stim post tibial | $144 | $71 | +104% | 93 |
| 46221 Ligation of hemorrhoid(s) | $888 | $442 | +101% | 100 |
| 20550 Njx 1 tendon sheath/ligament | $154 | $83 | +85% | 95 |
| 52224 Cystoscopy and treatment | $864 | $467 | +85% | 93 |
| 99495 Transj care mgmt mod f2f 14d | $493 | $273 | +81% | 103 |
Furthest below market
| Code | UHC | Market | Gap | Prov. |
|---|---|---|---|---|
| 93298 Rem interrog dev eval scrms | $102 | $125 | -18% | 93 |
| 76872 Us transrectal | $224 | $258 | -13% | 93 |
| 88342 Imhchem/imcytchm 1st antb | $124 | $139 | -11% | 101 |
| 73564 X-ray exam knee 4 or more | $66 | $73 | -10% | 95 |
| 73030 X-ray exam of shoulder | $49 | $54 | -10% | 95 |
| 77280 Ther rad simulaj field smpl | $400 | $435 | -8% | 101 |
| 88305 Tissue exam by pathologist | $81 | $87 | -7% | 201 |
| 88312 Special stains group 1 | $125 | $133 | -6% | 201 |
Where UnitedHealthcare pays above and below its national level
Frequently asked questions
Does UnitedHealthcare pay more or less than the other payers in Massachusetts?
UnitedHealthcare ranks 1st of 4 in Massachusetts with an index of 137. It is highest on 80% of codes.
Are UnitedHealthcare's Massachusetts rates above or below its national level?
About 52% above.
Which procedure does UnitedHealthcare pay most above market in Massachusetts?
CPT 45385 (Colonoscopy w/lesion removal), at 214% of the Massachusetts 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 Massachusetts?
Compare your negotiated rates for these codes with Massachusetts medians for each payer.