Idaho · state market

Commercial healthcare reimbursement in Idaho

How Idaho compares with the nation, by payer, specialty and procedure.

State indexSnapshot Aug 2026

Idaho at a glance

228 procedure codes, 8 specialties

Index vs national

109

9% above the national median

State rank

17 of 51

1 = highest

Median % of Medicare

165%

across tracked codes

Payers

618 sampled providers

What the data shows

Generated from this state's numbers

Idaho ranks 17th of 51 states for commercial reimbursement, with an index of 109 (100 = national median) across 228 procedure codes; the West region averages 118.

Commercial rates in Idaho run a median 165% of Medicare.

Aetna has the highest index in the state (112) and Cigna the lowest (97), a 15-point gap, in the files analyzed.

CPT 76872 (Us transrectal) is the strongest relative to the national median (149% of it, a 49% premium); CPT 52000 (Cystourethroscopy) is furthest below (73% of the national median, 27% lower).

By specialty, Idaho is strongest for ophthalmology (ranks 13th of 50 states for that specialty) and weakest for urology (24th of 50).

Against Medicare, gastroenterology has the highest ratio in Idaho (216% of Medicare) and dermatology the lowest (111%).

Payer ranking in Idaho

Index: 100 = the four-payer state median; counts are sampled providers and TINs

Payer	Index	Rank	Codes	Providers	TINs
Aetna	112	1	227	491	381
Blue Cross Blue Shield	107	2	228	547	428
UnitedHealthcare	98	3	228	546	335
Cigna	97	4	227	529	367

Reimbursement index by specialty in Idaho

100 = the specialty's national median; the Medicare column compares median rates with the CY2026 Medicare rate

Specialty	Index	Rank among states	% of Medicare	Codes	Providers
Ophthalmology	125	13 of 50	155%	42	57
Gastroenterology	115	15 of 50	216%	36	52
Diagnostic radiology	108	16 of 51	166%	49	125
Cardiology	106	18 of 51	155%	38	63
Dermatology	108	19 of 50	111%	44	46
Internal medicine	108	19 of 51	131%	25	109
Orthopedic surgery	106	21 of 51	155%	39	120
Urology	102	24 of 50	174%	37	46

Specialty by payer in Idaho

Index: 100 = the specialty's national median for the same codes; bold = highest payer for that specialty; n/a = fewer than 10 codes with enough data

Specialty	UHC	Aetna	Cigna	BCBS
Internal medicine	118	96	112	103
Dermatology	125	111	108	130
Ophthalmology	115	135	111	135
Cardiology	107	92	104	102
Orthopedic surgery	97	125	97	123
Diagnostic radiology	86	142	89	127
Urology	116	106	99	95
Gastroenterology	142	133	97	123

Idaho compared with West region states

Closest states in the West region by index; the region averages 118

State	Index	Rank	% of Medicare	Providers
Idaho	109	17	165%	618
Colorado	105	19	162%	948
Hawaii	102	21	138%	524
Montana	100	24	160%	448
Utah	100	25	154%	818
New Mexico	94	33	141%	622

Procedures that pay most and least in Idaho vs the nation

Median across payers; the 15 largest gaps in each direction

Highest vs national

Code	Idaho	National	Gap	Prov.
76872 Us transrectal	$281	$188	+49%	45
77280 Ther rad simulaj field smpl	$436	$302	+44%	46
68761 Close tear duct opening	$233	$164	+42%	57
67904 Repair eyelid defect	$1,155	$816	+41%	57
65820 Goniotomy	$1,300	$955	+36%	57
66821 After cataract laser surgery	$524	$393	+33%	57
76512 Oph us dx b-scan	$93	$70	+33%	57
65855 Trabeculoplasty laser surg	$406	$307	+32%	57
92242 Fluorescein&icg angiography	$378	$288	+31%	57
96910 Photchmtx tar&uvb/ptrltm&uvb	$163	$125	+30%	46
65756 Corneal trnspl endothelial	$1,853	$1,425	+30%	57
43235 Egd diagnostic brush wash	$380	$294	+29%	52
45378 Diagnostic colonoscopy	$526	$408	+29%	52
78452 Ht muscle image spect mult	$793	$617	+29%	171
43248 Egd guide wire insertion	$467	$364	+28%	52

Lowest vs national

Code	Idaho	National	Gap	Prov.
52000 Cystourethroscopy	$154	$210	-27%	45
51720 Treatment of bladder lesion	$84	$111	-24%	45
51700 Irrigation of bladder	$59	$77	-24%	45
51702 Insert temp bladder cath	$49	$61	-19%	46
93297 Rem interrog dev eval icpms	$43	$52	-18%	61
51798 Us urine capacity measure	$18	$21	-18%	45
52332 Cystoscopy and treatment	$296	$360	-18%	45
93298 Rem interrog dev eval scrms	$43	$52	-18%	63
52224 Cystoscopy and treatment	$388	$459	-16%	45
88342 Imhchem/imcytchm 1st antb	$81	$95	-15%	46
52281 Cystoscopy and treatment	$290	$334	-13%	45
88313 Special stains group 2	$61	$71	-13%	52
52310 Cystoscopy and treatment	$277	$317	-13%	45
52287 Cystoscopy chemodenervation	$323	$367	-12%	45
52648 Laser surgery of prostate	$1,330	$1,508	-12%	45

Frequently asked questions

Answers use this page's data

How do commercial reimbursement rates in Idaho compare with the rest of the country?

Idaho ranks 17th of 51 states with an index of 109, across 228 procedure codes. Median commercial rates run 165% of the Medicare rate.

Which payer has the highest rates in Idaho?

In the files we analyzed, Aetna has the highest index (112) and Cigna the lowest (97). 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 Idaho?

Ophthalmology ranks 13th of 50 states.

How many providers does this Idaho page cover?

618 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 Idaho and the national median?

CPT 76872 (Us transrectal) is highest relative to the nation at 149% of the national median; CPT 52000 (Cystourethroscopy) is lowest at 73%.

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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