Commercial healthcare reimbursement in Colorado
How Colorado compares with the nation, by payer, specialty and procedure.
Colorado at a glance
What the data shows
Colorado ranks 19th of 51 states for commercial reimbursement, with an index of 105 (100 = national median) across 228 procedure codes; the West region averages 118.
Commercial rates in Colorado run a median 162% of Medicare.
UnitedHealthcare has the highest index in the state (113) and Aetna the lowest (82), a 31-point gap, in the files analyzed.
CPT 93298 (Rem interrog dev eval scrms) is the strongest relative to the national median (152% of it, a 52% premium); CPT 43239 (Egd biopsy single/multiple) is furthest below (76% of the national median, 24% lower).
By specialty, Colorado is strongest for diagnostic radiology (ranks 14th of 51 states for that specialty) and weakest for cardiology (26th of 51).
Against Medicare, gastroenterology has the highest ratio in Colorado (179% of Medicare) and dermatology the lowest (97%).
Payer ranking in Colorado
| Payer | Index | Rank | Level | Codes | Providers | TINs |
|---|---|---|---|---|---|---|
| UnitedHealthcare | 113 | 1 | 228 | 749 | 456 | |
| Blue Cross Blue Shield | 100 | 2 | 228 | 796 | 671 | |
| Cigna | 94 | 3 | 227 | 752 | 469 | |
| Aetna | 82 | 4 | 227 | 717 | 479 |
Reimbursement index by specialty in Colorado
| Specialty | Index | Rank among states | % of Medicare | Level | Codes | Providers |
|---|---|---|---|---|---|---|
| Diagnostic radiology | 112 | 14 of 51 | 169% | 49 | 126 | |
| Internal medicine | 110 | 16 of 51 | 118% | 25 | 115 | |
| Ophthalmology | 116 | 16 of 50 | 136% | 42 | 104 | |
| Orthopedic surgery | 107 | 20 of 51 | 157% | 39 | 107 | |
| Dermatology | 101 | 23 of 50 | 97% | 44 | 125 | |
| Gastroenterology | 98 | 23 of 50 | 179% | 36 | 126 | |
| Urology | 102 | 25 of 50 | 172% | 37 | 116 | |
| Cardiology | 99 | 26 of 51 | 150% | 38 | 129 |
Specialty by payer in Colorado
| Specialty | UHC | Aetna | Cigna | BCBS |
|---|---|---|---|---|
| Internal medicine | 127 | 74 | 105 | 110 |
| Dermatology | 125 | 82 | 89 | 95 |
| Ophthalmology | 123 | 94 | 108 | 119 |
| Cardiology | 119 | 72 | 99 | 102 |
| Orthopedic surgery | 124 | 94 | 95 | 107 |
| Diagnostic radiology | 130 | 96 | 109 | 118 |
| Urology | 125 | 76 | 94 | 102 |
| Gastroenterology | 129 | 83 | 93 | 92 |
Colorado compared with West region states
Procedures that pay most and least in Colorado vs the nation
Highest vs national
| Code | Colorado | National | Gap | Prov. |
|---|---|---|---|---|
| 93298 Rem interrog dev eval scrms | $79 | $52 | +52% | 127 |
| 76872 Us transrectal | $239 | $188 | +27% | 115 |
| 93297 Rem interrog dev eval icpms | $66 | $52 | +26% | 127 |
| 92242 Fluorescein&icg angiography | $357 | $288 | +24% | 102 |
| 74176 Ct abd & pelvis w/o contrast | $352 | $287 | +23% | 116 |
| 99490 Chrnc care mgmt staff 1st 20 | $74 | $60 | +22% | 476 |
| 92201 Opscpy extnd rta draw uni/bi | $32 | $27 | +22% | 103 |
| 73564 X-ray exam knee 4 or more | $73 | $60 | +22% | 106 |
| 73610 X-ray exam of ankle | $57 | $47 | +22% | 106 |
| 73562 X-ray exam of knee 3 | $64 | $53 | +22% | 105 |
| 73560 X-ray exam of knee 1 or 2 | $54 | $45 | +21% | 106 |
| 73502 X-ray exam hip uni 2-3 views | $74 | $61 | +21% | 230 |
| 71045 X-ray exam chest 1 view | $40 | $33 | +21% | 123 |
| 99487 Cplx chrnc care 1st 60 min | $146 | $121 | +21% | 114 |
| 88313 Special stains group 2 | $85 | $71 | +20% | 124 |
Lowest vs national
| Code | Colorado | National | Gap | Prov. |
|---|---|---|---|---|
| 43239 Egd biopsy single/multiple | $267 | $349 | -24% | 126 |
| 45378 Diagnostic colonoscopy | $316 | $408 | -23% | 126 |
| 45380 Colonoscopy and biopsy | $371 | $470 | -21% | 126 |
| 52000 Cystourethroscopy | $167 | $210 | -20% | 114 |
| 43235 Egd diagnostic brush wash | $237 | $294 | -19% | 125 |
| 51700 Irrigation of bladder | $62 | $77 | -19% | 113 |
| 51720 Treatment of bladder lesion | $90 | $111 | -19% | 113 |
| 43248 Egd guide wire insertion | $299 | $364 | -18% | 125 |
| 45385 Colonoscopy w/lesion removal | $452 | $549 | -18% | 241 |
| 43251 Egd remove lesion snare | $352 | $425 | -17% | 126 |
| 51702 Insert temp bladder cath | $50 | $61 | -17% | 113 |
| 45384 Colonoscopy w/lesion removal | $431 | $519 | -17% | 124 |
| 43255 Egd control bleeding any | $382 | $459 | -17% | 125 |
| 51798 Us urine capacity measure | $18 | $21 | -16% | 114 |
| 64566 Neuroeltrd stim post tibial | $58 | $69 | -16% | 113 |
Frequently asked questions
How do commercial reimbursement rates in Colorado compare with the rest of the country?
Colorado ranks 19th of 51 states with an index of 105, across 228 procedure codes. Median commercial rates run 162% of the Medicare rate.
Which payer has the highest rates in Colorado?
In the files we analyzed, UnitedHealthcare has the highest index (113) and Aetna the lowest (82). 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 Colorado?
Diagnostic radiology ranks 14th of 51 states.
How many providers does this Colorado page cover?
948 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 Colorado and the national median?
CPT 93298 (Rem interrog dev eval scrms) is highest relative to the nation at 152% of the national median; CPT 43239 (Egd biopsy single/multiple) is lowest at 76%.
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 Colorado contracts
Compare your negotiated rates with these state medians by payer and specialty.