Commercial healthcare reimbursement in Iowa
How Iowa compares with the nation, by payer, specialty and procedure.
Iowa at a glance
What the data shows
Iowa ranks 8th of 51 states for commercial reimbursement, with an index of 128 (100 = national median) across 228 procedure codes; the Midwest region averages 115.
Commercial rates in Iowa run a median 195% of Medicare.
UnitedHealthcare has the highest index in the state (118) and Aetna the lowest (64), a 55-point gap, in the files analyzed.
CPT 88342 (Imhchem/imcytchm 1st antb) is the strongest relative to the national median (242% of it, a 142% premium); CPT 51720 (Treatment of bladder lesion) is furthest below (86% of the national median, 14% lower).
By specialty, Iowa is strongest for ophthalmology (ranks 7th of 50 states for that specialty) and weakest for internal medicine (22nd of 51).
Against Medicare, gastroenterology has the highest ratio in Iowa (228% of Medicare) and internal medicine the lowest (123%).
Payer ranking in Iowa
| Payer | Index | Rank | Level | Codes | Providers | TINs |
|---|---|---|---|---|---|---|
| UnitedHealthcare | 118 | 1 | 228 | 605 | 336 | |
| Cigna | 117 | 2 | 227 | 604 | 282 | |
| Blue Cross Blue Shield | 99 | 3 | 228 | 687 | 440 | |
| Aetna | 64 | 4 | 202 | 295 | 196 |
Reimbursement index by specialty in Iowa
| Specialty | Index | Rank among states | % of Medicare | Level | Codes | Providers |
|---|---|---|---|---|---|---|
| Ophthalmology | 147 | 7 of 50 | 179% | 42 | 93 | |
| Orthopedic surgery | 129 | 8 of 51 | 200% | 39 | 104 | |
| Diagnostic radiology | 117 | 9 of 51 | 195% | 49 | 102 | |
| Gastroenterology | 117 | 12 of 50 | 228% | 36 | 57 | |
| Dermatology | 135 | 13 of 50 | 138% | 44 | 63 | |
| Cardiology | 122 | 15 of 51 | 200% | 38 | 113 | |
| Urology | 108 | 17 of 50 | 200% | 37 | 84 | |
| Internal medicine | 105 | 22 of 51 | 123% | 25 | 100 |
Specialty by payer in Iowa
| Specialty | UHC | Aetna | Cigna | BCBS |
|---|---|---|---|---|
| Internal medicine | 172 | 65 | 133 | 94 |
| Dermatology | 155 | 104 | 180 | 116 |
| Ophthalmology | 191 | 87 | 198 | 134 |
| Cardiology | 168 | 75 | 148 | 121 |
| Orthopedic surgery | 145 | 81 | 143 | 120 |
| Diagnostic radiology | 112 | 72 | 133 | 123 |
| Urology | 143 | 68 | 127 | 96 |
| Gastroenterology | 148 | 72 | 133 | 109 |
Iowa compared with Midwest region states
| State | Index | Rank | % of Medicare | Providers | Level |
|---|---|---|---|---|---|
| Iowa | 128 | 8 | 195% | 716 | |
| North Dakota | 127 | 9 | 197% | 369 | |
| Minnesota | 126 | 10 | 167% | 853 | |
| South Dakota | 135 | 6 | 202% | 474 | |
| Nebraska | 138 | 4 | 198% | 601 | |
| Ohio | 99 | 27 | 156% | 937 |
Procedures that pay most and least in Iowa vs the nation
Highest vs national
| Code | Iowa | National | Gap | Prov. |
|---|---|---|---|---|
| 88342 Imhchem/imcytchm 1st antb | $230 | $95 | +142% | 63 |
| 92242 Fluorescein&icg angiography | $597 | $288 | +107% | 93 |
| 93298 Rem interrog dev eval scrms | $107 | $52 | +104% | 113 |
| 88313 Special stains group 2 | $143 | $71 | +103% | 55 |
| 88312 Special stains group 1 | $194 | $97 | +100% | 118 |
| 77280 Ther rad simulaj field smpl | $597 | $302 | +98% | 63 |
| 92235 Fluorescein angrph mltiframe | $283 | $145 | +96% | 93 |
| 88305 Tissue exam by pathologist | $125 | $70 | +79% | 118 |
| 92004 Compre oph exam new pt 1/> | $216 | $124 | +74% | 93 |
| 92136 Ophthalmic biometry | $119 | $69 | +72% | 93 |
| 66821 After cataract laser surgery | $676 | $393 | +72% | 93 |
| 92250 Fundus photography w/i&r | $89 | $53 | +69% | 93 |
| 92014 Compre oph exam est pt 1/> | $167 | $101 | +65% | 93 |
| 92025 Cptrized corneal topography | $66 | $40 | +64% | 93 |
| 67210 Treatment of retinal lesion | $1,051 | $659 | +59% | 93 |
Lowest vs national
| Code | Iowa | National | Gap | Prov. |
|---|---|---|---|---|
| 51720 Treatment of bladder lesion | $95 | $111 | -14% | 83 |
| 52000 Cystourethroscopy | $191 | $210 | -9% | 83 |
| 51702 Insert temp bladder cath | $56 | $61 | -8% | 83 |
| 51700 Irrigation of bladder | $71 | $77 | -8% | 83 |
| 99426 Prin care mgmt staff 1st 30 | $71 | $77 | -7% | 82 |
| 64566 Neuroeltrd stim post tibial | $65 | $69 | -6% | 83 |
| 99454 Rem mntr physiol param 16-30 | $71 | $75 | -5% | 211 |
| 99202 Office o/p new sf 15 min | $68 | $70 | -2% | 63 |
| 99497 Advncd care plan 30 min | $107 | $108 | -2% | 99 |
| 43255 Egd control bleeding any | $452 | $459 | -1% | 55 |
| 99496 Transj care mgmt high f2f 7d | $287 | $291 | -1% | 99 |
| 99495 Transj care mgmt mod f2f 14d | $211 | $211 | +0% | 99 |
| 52224 Cystoscopy and treatment | $461 | $459 | +0% | 83 |
| 52648 Laser surgery of prostate | $1,518 | $1,508 | +1% | 83 |
| 99203 Office o/p new low 30 min | $119 | $118 | +1% | 712 |
Frequently asked questions
How do commercial reimbursement rates in Iowa compare with the rest of the country?
Iowa ranks 8th of 51 states with an index of 128, across 228 procedure codes. Median commercial rates run 195% of the Medicare rate.
Which payer has the highest rates in Iowa?
In the files we analyzed, UnitedHealthcare has the highest index (118) and Aetna the lowest (64). 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 Iowa?
Ophthalmology ranks 7th of 50 states.
How many providers does this Iowa page cover?
716 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 Iowa and the national median?
CPT 88342 (Imhchem/imcytchm 1st antb) is highest relative to the nation at 242% of the national median; CPT 51720 (Treatment of bladder lesion) is lowest at 86%.
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 Iowa contracts
Compare your negotiated rates with these state medians by payer and specialty.