UnitedHealthcare · Pennsylvania · commercial in-network

UnitedHealthcare negotiated rates in Pennsylvania

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

UnitedHealthcare in Pennsylvania at a glance

Across 228 procedure codes for 8 specialties
Rate index vs state market
115
15% above the Pennsylvania median
Rank in state
1 of 4
UHC 115 · BCBS 101 · Cigna 94 · Aetna 82
vs own national
96
UHC's level vs its national median
Codes where highest
75%
of 228 codes
751 sampled providers498 TINs228 codesMedian 171% of Medicare · method

What the data shows

Generated from Pennsylvania and UnitedHealthcare data only
1

UnitedHealthcare ranks 1st of 4 payers in Pennsylvania with a rate index of 115 (100 = the Pennsylvania market median), across 228 procedure codes.

2

UnitedHealthcare has the highest median for 75% of codes in Pennsylvania.

3

UnitedHealthcare's Pennsylvania rates sit 4% below its own national level, the 29th highest of its 51 states.

4

Largest premium over the Pennsylvania market: CPT 43255 (Egd control bleeding any) at 248% of market; largest discount: CPT 92235 (Fluorescein angrph mltiframe) at 87%.

How the four payers compare in Pennsylvania

Rate index: 100 = the state four-payer median for the same codes
PayerIndexRankLevelHighest onProviders
UnitedHealthcare1151
115
75%751
Blue Cross Blue Shield1012
101
18%564
Cigna943
94
2%788
Aetna824
82
5%679

Where UnitedHealthcare pays most and least against the Pennsylvania market

Codes with the largest gap to the state median

Highest above market

CodeUHCMarketGapProv.
43255
Egd control bleeding any
$1,132$456+148%107
52224
Cystoscopy and treatment
$1,098$477+130%92
64566
Neuroeltrd stim post tibial
$164$77+112%92
43251
Egd remove lesion snare
$826$440+88%107
52332
Cystoscopy and treatment
$671$366+83%93
43248
Egd guide wire insertion
$674$372+81%107
52648
Laser surgery of prostate
$2,476$1,374+80%93
43239
Egd biopsy single/multiple
$645$365+77%107

Furthest below market

CodeUHCMarketGapProv.
92235
Fluorescein angrph mltiframe
$107$123-13%98
96574
Dbrdmt prmlg les w/pdt
$268$308-13%98
51798
Us urine capacity measure
$18$20-12%93
96372
Ther/proph/diag inj sc/im
$23$24-4%90
92242
Fluorescein&icg angiography
$241$249-3%98
88312
Special stains group 1
$102$105-3%205
96910
Photchmtx tar&uvb/ptrltm&uvb
$118$121-3%98
88313
Special stains group 2
$73$74-2%107

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 Pennsylvania?

UnitedHealthcare ranks 1st of 4 in Pennsylvania with an index of 115. It is highest on 75% of codes.

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

About 4% below.

Which procedure does UnitedHealthcare pay most above market in Pennsylvania?

CPT 43255 (Egd control bleeding any), at 248% of the Pennsylvania 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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