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
What the data shows
UnitedHealthcare ranks 1st of 4 payers in Pennsylvania with a rate index of 115 (100 = the Pennsylvania market median), across 228 procedure codes.
UnitedHealthcare has the highest median for 75% of codes in Pennsylvania.
UnitedHealthcare's Pennsylvania rates sit 4% below its own national level, the 29th highest of its 51 states.
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
| Payer | Index | Rank | Level | Highest on | Providers |
|---|---|---|---|---|---|
| UnitedHealthcare | 115 | 1 | 75% | 751 | |
| Blue Cross Blue Shield | 101 | 2 | 18% | 564 | |
| Cigna | 94 | 3 | 2% | 788 | |
| Aetna | 82 | 4 | 5% | 679 |
Where UnitedHealthcare pays most and least against the Pennsylvania market
Highest above market
| Code | UHC | Market | Gap | Prov. |
|---|---|---|---|---|
| 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
| Code | UHC | Market | Gap | Prov. |
|---|---|---|---|---|
| 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
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
- 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 Pennsylvania?
Compare your negotiated rates for these codes with Pennsylvania medians for each payer.