UnitedHealthcare · New York · commercial in-network

UnitedHealthcare negotiated rates in New York

How UnitedHealthcare's New York rates compare with the other three national payers, across the procedures that matter most to high-revenue specialties.

UnitedHealthcare in New York at a glance

Across 228 procedure codes for 8 specialties
Rate index vs state market
128
28% above the New York median
Rank in state
1 of 4
UHC 128 · Cigna 120 · BCBS 97 · Aetna 83
vs own national
101
UHC's level vs its national median
Codes where highest
41%
of 228 codes
801 sampled providers665 TINs228 codesMedian 164% of Medicare · method

What the data shows

Generated from New York and UnitedHealthcare data only
1

UnitedHealthcare ranks 1st of 4 payers in New York with a rate index of 128 (100 = the New York market median), across 228 procedure codes.

2

UnitedHealthcare has the highest median for only 41% of codes in New York; UnitedHealthcare leads with an index of 128 in the files analyzed.

3

UnitedHealthcare's New York rates sit 1% above its own national level, the 24th highest of its 51 states.

4

Largest premium over the New York market: CPT 20550 (Njx 1 tendon sheath/ligament) at 184% of market; largest discount: CPT 76512 (Oph us dx b-scan) at 74%.

How the four payers compare in New York

Rate index: 100 = the state four-payer median for the same codes
PayerIndexRankLevelHighest onProviders
UnitedHealthcare1281
128
41%801
Cigna1202
120
46%672
Blue Cross Blue Shield973
97
8%898
Aetna834
83
5%755

Where UnitedHealthcare pays most and least against the New York market

Codes with the largest gap to the state median

Highest above market

CodeUHCMarketGapProv.
20550
Njx 1 tendon sheath/ligament
$133$73+84%92
26055
Incise finger tendon sheath
$1,155$663+74%89
20611
Drain/inj joint/bursa w/us
$200$117+71%92
52281
Cystoscopy and treatment
$551$332+66%106
52287
Cystoscopy chemodenervation
$622$378+64%106
52310
Cystoscopy and treatment
$510$314+63%106
93296
Rem interrog evl pm/ids
$48$30+61%111
99457
Rpm tx mgmt 1st 20 min
$80$50+60%205

Furthest below market

CodeUHCMarketGapProv.
76512
Oph us dx b-scan
$50$68-26%96
88305
Tissue exam by pathologist
$53$68-21%211
88313
Special stains group 2
$58$73-21%121
88312
Special stains group 1
$77$94-18%211
77280
Ther rad simulaj field smpl
$302$354-15%90
72148
Mri lumbar spine w/o dye
$328$370-11%180
65778
Cover eye w/membrane
$57$64-11%96
66984
Xcapsl ctrc rmvl w/o ecp
$598$669-11%96

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 New York?

UnitedHealthcare ranks 1st of 4 in New York with an index of 128. It is highest on 41% of codes.

Are UnitedHealthcare's New York rates above or below its national level?

About 1% above.

Which procedure does UnitedHealthcare pay most above market in New York?

CPT 20550 (Njx 1 tendon sheath/ligament), at 184% of the New York 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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