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
What the data shows
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.
UnitedHealthcare has the highest median for only 41% of codes in New York; UnitedHealthcare leads with an index of 128 in the files analyzed.
UnitedHealthcare's New York rates sit 1% above its own national level, the 24th highest of its 51 states.
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
| Payer | Index | Rank | Level | Highest on | Providers |
|---|---|---|---|---|---|
| UnitedHealthcare | 128 | 1 | 41% | 801 | |
| Cigna | 120 | 2 | 46% | 672 | |
| Blue Cross Blue Shield | 97 | 3 | 8% | 898 | |
| Aetna | 83 | 4 | 5% | 755 |
Where UnitedHealthcare pays most and least against the New York market
Highest above market
| Code | UHC | Market | Gap | Prov. |
|---|---|---|---|---|
| 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
| Code | UHC | Market | Gap | Prov. |
|---|---|---|---|---|
| 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
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
- 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 New York?
Compare your negotiated rates for these codes with New York medians for each payer.