Commercial healthcare reimbursement in District of Columbia
How District of Columbia compares with the nation, by payer, specialty and procedure.
District of Columbia at a glance
What the data shows
District of Columbia ranks 20th of 51 states for commercial reimbursement, with an index of 104 (100 = national median) across 228 procedure codes; the South region averages 94.
Commercial rates in District of Columbia run a median 154% of Medicare.
UnitedHealthcare has the highest index in the state (142) and Blue Cross Blue Shield the lowest (66), a 76-point gap, in the files analyzed.
CPT 76872 (Us transrectal) is the strongest relative to the national median (166% of it, a 66% premium); CPT 11301 (Shave skin lesion 0.6-1.0 cm) is furthest below (63% of the national median, 37% lower).
By specialty, District of Columbia is strongest for urology (ranks 5th of 50 states for that specialty) and weakest for dermatology (47th of 50).
Against Medicare, urology has the highest ratio in District of Columbia (222% of Medicare) and dermatology the lowest (77%).
Payer ranking in District of Columbia
| Payer | Index | Rank | Level | Codes | Providers | TINs |
|---|---|---|---|---|---|---|
| UnitedHealthcare | 142 | 1 | 228 | 396 | 267 | |
| Cigna | 121 | 2 | 227 | 430 | 284 | |
| Aetna | 102 | 3 | 226 | 357 | 317 | |
| Blue Cross Blue Shield | 66 | 4 | 228 | 484 | 443 |
Reimbursement index by specialty in District of Columbia
| Specialty | Index | Rank among states | % of Medicare | Level | Codes | Providers |
|---|---|---|---|---|---|---|
| Urology | 131 | 5 of 50 | 222% | 37 | 49 | |
| Orthopedic surgery | 130 | 7 of 51 | 191% | 39 | 35 | |
| Internal medicine | 120 | 11 of 51 | 136% | 25 | 84 | |
| Cardiology | 125 | 13 of 51 | 181% | 38 | 80 | |
| Gastroenterology | 105 | 20 of 50 | 175% | 36 | 51 | |
| Diagnostic radiology | 100 | 26 of 51 | 149% | 49 | 133 | |
| Ophthalmology | 87 | 41 of 50 | 102% | 42 | 52 | |
| Dermatology | 77 | 47 of 50 | 77% | 44 | 37 |
Specialty by payer in District of Columbia
| Specialty | UHC | Aetna | Cigna | BCBS |
|---|---|---|---|---|
| Internal medicine | 162 | 113 | 130 | 74 |
| Dermatology | 103 | 70 | 69 | 75 |
| Ophthalmology | 90 | 93 | 89 | 71 |
| Cardiology | 179 | 150 | 179 | 73 |
| Orthopedic surgery | 163 | 154 | 148 | 66 |
| Diagnostic radiology | 180 | 87 | 120 | 71 |
| Urology | 170 | 146 | 163 | 75 |
| Gastroenterology | 157 | 116 | 148 | 68 |
District of Columbia compared with South region states
| State | Index | Rank | % of Medicare | Providers | Level |
|---|---|---|---|---|---|
| District of Columbia | 104 | 20 | 154% | 521 | |
| Mississippi | 111 | 16 | 159% | 778 | |
| Tennessee | 96 | 29 | 143% | 944 | |
| North Carolina | 115 | 15 | 175% | 1,009 | |
| West Virginia | 93 | 34 | 146% | 608 | |
| Arkansas | 93 | 36 | 144% | 788 |
Procedures that pay most and least in District of Columbia vs the nation
Highest vs national
| Code | District of | National | Gap | Prov. |
|---|---|---|---|---|
| 76872 Us transrectal | $312 | $188 | +66% | 47 |
| 76857 Us exam pelvic limited | $111 | $75 | +49% | 47 |
| 76775 Us exam abdo back wall lim | $135 | $92 | +46% | 47 |
| 55874 Tprnl plmt biodegrdabl matrl | $365 | $257 | +42% | 46 |
| 51729 Cystometrogram w/vp&up | $773 | $554 | +39% | 47 |
| 93925 Lower extremity study | $484 | $349 | +39% | 80 |
| 29848 Wrist endoscopy/surgery | $1,124 | $817 | +38% | 35 |
| 52601 Prostatectomy (turp) | $1,617 | $1,181 | +37% | 47 |
| 97110 Therapeutic exercises | $43 | $31 | +37% | 35 |
| 52356 Cysto/uretero w/lithotripsy | $893 | $657 | +36% | 48 |
| 55866 Laps surg prst8ect rpbic rad | $3,029 | $2,237 | +35% | 48 |
| 20550 Njx 1 tendon sheath/ligament | $100 | $74 | +35% | 35 |
| 51728 Cystometrogram w/vp | $703 | $520 | +35% | 47 |
| 29827 Sho arthrs srg rt8tr cuf rpr | $2,291 | $1,701 | +35% | 35 |
| 75574 Ct angio hrt w/3d image | $667 | $495 | +35% | 80 |
Lowest vs national
| Code | District of | National | Gap | Prov. |
|---|---|---|---|---|
| 11301 Shave skin lesion 0.6-1.0 cm | $54 | $85 | -37% | 36 |
| 17313 Mohs 1 stage t/a/l | $342 | $515 | -33% | 36 |
| 17261 Dstrj mal les t/a/l .6-1.0cm | $89 | $132 | -33% | 36 |
| 11104 Punch bx skin single lesion | $56 | $81 | -30% | 35 |
| 11102 Tangntl bx skin single les | $45 | $65 | -30% | 36 |
| 17282 Dstr mal ls f/e/e/n/l/m1.1-2 | $138 | $195 | -29% | 35 |
| 76512 Oph us dx b-scan | $50 | $70 | -29% | 51 |
| 11602 Exc tr-ext mal+marg 1.1-2 cm | $163 | $228 | -28% | 36 |
| 17110 Destruction b9 les up to 14 | $73 | $101 | -28% | 36 |
| 13152 Cmplx rpr e/n/e/l 2.6-7.5 cm | $363 | $498 | -27% | 36 |
| 11603 Exc tr-ext mal+marg 2.1-3 cm | $195 | $267 | -27% | 36 |
| 11302 Shave skin lesion 1.1-2.0 cm | $72 | $98 | -27% | 36 |
| 13132 Cmplx rpr f/c/c/m/n/ax/g/h/f | $343 | $470 | -27% | 35 |
| 17111 Destruction b9 lesions 15/> | $88 | $120 | -26% | 35 |
| 17311 Mohs 1 stage h/n/hf/g | $426 | $577 | -26% | 36 |
Frequently asked questions
How do commercial reimbursement rates in District of Columbia compare with the rest of the country?
District of Columbia ranks 20th of 51 states with an index of 104, across 228 procedure codes. Median commercial rates run 154% of the Medicare rate.
Which payer has the highest rates in District of Columbia?
In the files we analyzed, UnitedHealthcare has the highest index (142) and Blue Cross Blue Shield the lowest (66). 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 District of Columbia?
Urology ranks 5th of 50 states.
How many providers does this District of Columbia page cover?
521 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 District of Columbia and the national median?
CPT 76872 (Us transrectal) is highest relative to the nation at 166% of the national median; CPT 11301 (Shave skin lesion 0.6-1.0 cm) is lowest at 63%.
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 District of Columbia contracts
Compare your negotiated rates with these state medians by payer and specialty.