Commercial healthcare reimbursement in California
How California compares with the nation, by payer, specialty and procedure.
California at a glance
What the data shows
California ranks 35th of 51 states for commercial reimbursement, with an index of 93 (100 = national median) across 228 procedure codes; the West region averages 118.
Commercial rates in California run a median 138% of Medicare.
UnitedHealthcare has the highest index in the state (126) and Aetna the lowest (84), a 42-point gap, in the files analyzed.
CPT 77080 (Dxa bone density axial) is the strongest relative to the national median (151% of it, a 51% premium); CPT 93297 (Rem interrog dev eval icpms) is furthest below (67% of the national median, 33% lower).
By specialty, California is strongest for urology (ranks 20th of 50 states for that specialty) and weakest for orthopedic surgery (41st of 51).
Against Medicare, urology has the highest ratio in California (172% of Medicare) and dermatology the lowest (93%).
Payer ranking in California
| Payer | Index | Rank | Level | Codes | Providers | TINs |
|---|---|---|---|---|---|---|
| UnitedHealthcare | 126 | 1 | 228 | 658 | 615 | |
| Cigna | 112 | 2 | 227 | 648 | 531 | |
| Blue Cross Blue Shield | 96 | 3 | 228 | 807 | 1,237 | |
| Aetna | 84 | 4 | 228 | 566 | 796 |
Reimbursement index by specialty in California
| Specialty | Index | Rank among states | % of Medicare | Level | Codes | Providers |
|---|---|---|---|---|---|---|
| Urology | 106 | 20 of 50 | 172% | 37 | 95 | |
| Diagnostic radiology | 100 | 24 of 51 | 148% | 49 | 107 | |
| Internal medicine | 99 | 25 of 51 | 109% | 25 | 97 | |
| Ophthalmology | 96 | 28 of 50 | 115% | 42 | 122 | |
| Dermatology | 92 | 35 of 50 | 93% | 44 | 98 | |
| Cardiology | 89 | 40 of 51 | 133% | 38 | 108 | |
| Gastroenterology | 90 | 40 of 50 | 166% | 36 | 108 | |
| Orthopedic surgery | 88 | 41 of 51 | 123% | 39 | 109 |
Specialty by payer in California
| Specialty | UHC | Aetna | Cigna | BCBS |
|---|---|---|---|---|
| Internal medicine | 129 | 75 | 128 | 94 |
| Dermatology | 110 | 81 | 94 | 90 |
| Ophthalmology | 92 | 92 | 98 | 95 |
| Cardiology | 112 | 75 | 109 | 88 |
| Orthopedic surgery | 100 | 75 | 101 | 86 |
| Diagnostic radiology | 144 | 83 | 106 | 92 |
| Urology | 173 | 73 | 133 | 99 |
| Gastroenterology | 136 | 73 | 99 | 84 |
California compared with West region states
| State | Index | Rank | % of Medicare | Providers | Level |
|---|---|---|---|---|---|
| California | 93 | 35 | 138% | 844 | |
| New Mexico | 94 | 33 | 141% | 622 | |
| Nevada | 87 | 43 | 128% | 780 | |
| Utah | 100 | 25 | 154% | 818 | |
| Montana | 100 | 24 | 160% | 448 | |
| Hawaii | 102 | 21 | 138% | 524 |
Procedures that pay most and least in California vs the nation
Highest vs national
| Code | California | National | Gap | Prov. |
|---|---|---|---|---|
| 77080 Dxa bone density axial | $100 | $66 | +51% | 106 |
| 88305 Tissue exam by pathologist | $100 | $70 | +43% | 204 |
| 92250 Fundus photography w/i&r | $72 | $53 | +37% | 122 |
| 76857 Us exam pelvic limited | $100 | $75 | +34% | 95 |
| 51702 Insert temp bladder cath | $79 | $61 | +30% | 94 |
| 76512 Oph us dx b-scan | $90 | $70 | +28% | 121 |
| 76775 Us exam abdo back wall lim | $116 | $92 | +26% | 95 |
| 92136 Ophthalmic biometry | $85 | $69 | +23% | 122 |
| 88313 Special stains group 2 | $87 | $71 | +23% | 107 |
| 51798 Us urine capacity measure | $26 | $21 | +21% | 95 |
| 72141 Mri neck spine w/o dye | $469 | $390 | +20% | 106 |
| 11104 Punch bx skin single lesion | $96 | $81 | +19% | 97 |
| 11102 Tangntl bx skin single les | $77 | $65 | +18% | 97 |
| 70551 Mri brain stem w/o dye | $475 | $402 | +18% | 106 |
| 65778 Cover eye w/membrane | $82 | $70 | +17% | 121 |
Lowest vs national
| Code | California | National | Gap | Prov. |
|---|---|---|---|---|
| 93297 Rem interrog dev eval icpms | $35 | $52 | -33% | 108 |
| 36465 Njx noncmpnd sclrsnt 1 vein | $128 | $185 | -31% | 106 |
| 22612 Arthrd pst tq 1ntrspc lumbar | $1,843 | $2,557 | -28% | 109 |
| 27236 Treat thigh fracture | $1,387 | $1,918 | -28% | 107 |
| 29827 Sho arthrs srg rt8tr cuf rpr | $1,240 | $1,701 | -27% | 109 |
| 29848 Wrist endoscopy/surgery | $596 | $817 | -27% | 107 |
| 36482 Endoven ther chem adhes 1st | $203 | $278 | -27% | 106 |
| 63047 Lam facetec & foramot lumbar | $1,313 | $1,796 | -27% | 109 |
| 22558 Arthrd ant ntrbd min dsc lum | $1,810 | $2,471 | -27% | 107 |
| 22633 Arthrd cmbn 1ntrspc lumbar | $2,239 | $2,991 | -25% | 109 |
| 67904 Repair eyelid defect | $611 | $816 | -25% | 121 |
| 27487 Revise/replace knee joint | $2,127 | $2,840 | -25% | 107 |
| 22551 Arthrd ant ntrbdy cervical | $2,090 | $2,778 | -25% | 109 |
| 65820 Goniotomy | $719 | $955 | -25% | 121 |
| 33285 Insj subq car rhythm mntr | $102 | $135 | -25% | 106 |
Frequently asked questions
How do commercial reimbursement rates in California compare with the rest of the country?
California ranks 35th of 51 states with an index of 93, across 228 procedure codes. Median commercial rates run 138% of the Medicare rate.
Which payer has the highest rates in California?
In the files we analyzed, UnitedHealthcare has the highest index (126) and Aetna the lowest (84). Each payer's figures describe the specific plans and networks in the files used, not its whole book of business.
Which specialty has the strongest rates in California?
Urology ranks 20th of 50 states.
How many providers does this California page cover?
844 sampled providers across 4 payers. The data comes from a random sample of providers, so counts describe the sample, not every provider in the state.
Which procedures differ most between California and the national median?
CPT 77080 (Dxa bone density axial) is highest relative to the nation at 151% of the national median; CPT 93297 (Rem interrog dev eval icpms) is lowest at 67%.
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.
Benchmark your California contracts
Compare your negotiated rates with these state medians by payer and specialty.