Commercial healthcare reimbursement in Massachusetts
How Massachusetts compares with the nation, by payer, specialty and procedure.
Massachusetts at a glance
What the data shows
Massachusetts ranks 13th of 51 states for commercial reimbursement, with an index of 123 (100 = national median) across 228 procedure codes; the Northeast region averages 107.
Commercial rates in Massachusetts run a median 190% of Medicare.
UnitedHealthcare has the highest index in the state (137) and Aetna the lowest (62), a 75-point gap, in the files analyzed.
CPT 93298 (Rem interrog dev eval scrms) is the strongest relative to the national median (239% of it, a 139% premium); CPT 77080 (Dxa bone density axial) is furthest below (86% of the national median, 14% lower).
By specialty, Massachusetts is strongest for internal medicine (ranks 7th of 51 states for that specialty) and weakest for diagnostic radiology (17th of 51).
Against Medicare, gastroenterology has the highest ratio in Massachusetts (221% of Medicare) and dermatology the lowest (143%).
Payer ranking in Massachusetts
| Payer | Index | Rank | Level | Codes | Providers | TINs |
|---|---|---|---|---|---|---|
| UnitedHealthcare | 137 | 1 | 228 | 772 | 498 | |
| Cigna | 109 | 2 | 227 | 808 | 534 | |
| Blue Cross Blue Shield | 98 | 3 | 228 | 837 | 858 | |
| Aetna | 62 | 4 | 228 | 595 | 535 |
Reimbursement index by specialty in Massachusetts
| Specialty | Index | Rank among states | % of Medicare | Level | Codes | Providers |
|---|---|---|---|---|---|---|
| Internal medicine | 135 | 7 of 51 | 150% | 25 | 121 | |
| Dermatology | 148 | 8 of 50 | 143% | 44 | 116 | |
| Ophthalmology | 135 | 8 of 50 | 157% | 42 | 118 | |
| Gastroenterology | 122 | 9 of 50 | 221% | 36 | 114 | |
| Cardiology | 133 | 9 of 51 | 206% | 38 | 109 | |
| Orthopedic surgery | 120 | 12 of 51 | 183% | 39 | 111 | |
| Urology | 110 | 15 of 50 | 190% | 37 | 112 | |
| Diagnostic radiology | 108 | 17 of 51 | 160% | 49 | 120 |
Specialty by payer in Massachusetts
| Specialty | UHC | Aetna | Cigna | BCBS |
|---|---|---|---|---|
| Internal medicine | 219 | 78 | 150 | 130 |
| Dermatology | 182 | 85 | 159 | 146 |
| Ophthalmology | 174 | 94 | 154 | 144 |
| Cardiology | 194 | 74 | 138 | 128 |
| Orthopedic surgery | 179 | 75 | 128 | 115 |
| Diagnostic radiology | 156 | 72 | 127 | 113 |
| Urology | 157 | 70 | 124 | 99 |
| Gastroenterology | 192 | 92 | 128 | 115 |
Massachusetts compared with Northeast region states
| State | Index | Rank | % of Medicare | Providers | Level |
|---|---|---|---|---|---|
| Massachusetts | 123 | 13 | 190% | 921 | |
| New Hampshire | 121 | 14 | 174% | 734 | |
| Connecticut | 124 | 12 | 201% | 935 | |
| Vermont | 107 | 18 | 157% | 365 | |
| New Jersey | 100 | 22 | 154% | 887 | |
| Maine | 100 | 23 | 148% | 647 |
Procedures that pay most and least in Massachusetts vs the nation
Highest vs national
| Code | Massachusett | National | Gap | Prov. |
|---|---|---|---|---|
| 93298 Rem interrog dev eval scrms | $125 | $52 | +139% | 108 |
| 93297 Rem interrog dev eval icpms | $101 | $52 | +92% | 107 |
| 96910 Photchmtx tar&uvb/ptrltm&uvb | $196 | $125 | +57% | 116 |
| 17000 Destruct premalg lesion | $108 | $69 | +56% | 116 |
| 14040 Tis trnfr f/c/c/m/n/a/g/h/f | $1,250 | $800 | +56% | 116 |
| 14060 Tis trnfr e/n/e/l 10 sq cm/< | $1,296 | $835 | +55% | 116 |
| 14061 Tis trnfr e/n/e/l10.1-30sqcm | $1,664 | $1,074 | +55% | 116 |
| 90960 Esrd srv 4 visits p mo 20+ | $699 | $453 | +55% | 118 |
| 14041 Tis trnfr f/c/c/m/n/a/g/h/f | $1,522 | $991 | +54% | 116 |
| 17111 Destruction b9 lesions 15/> | $185 | $120 | +54% | 116 |
| 17282 Dstr mal ls f/e/e/n/l/m1.1-2 | $299 | $195 | +53% | 116 |
| 15260 Fth/gft fr n/e/e/l 20 sqcm/< | $1,649 | $1,078 | +53% | 116 |
| 11302 Shave skin lesion 1.1-2.0 cm | $149 | $98 | +52% | 116 |
| 12052 Intmd rpr face/mm 2.6-5.0 cm | $438 | $289 | +52% | 116 |
| 11301 Shave skin lesion 0.6-1.0 cm | $128 | $85 | +52% | 116 |
Lowest vs national
| Code | Massachusett | National | Gap | Prov. |
|---|---|---|---|---|
| 77080 Dxa bone density axial | $57 | $66 | -14% | 118 |
| 76857 Us exam pelvic limited | $67 | $75 | -10% | 103 |
| 76775 Us exam abdo back wall lim | $87 | $92 | -6% | 103 |
| 52000 Cystourethroscopy | $208 | $210 | -1% | 112 |
| 55866 Laps surg prst8ect rpbic rad | $2,236 | $2,237 | -0% | 112 |
| 76642 Ultrasound breast limited | $120 | $120 | +0% | 118 |
| 76641 Ultrasound breast complete | $146 | $145 | +0% | 118 |
| 52601 Prostatectomy (turp) | $1,185 | $1,181 | +0% | 112 |
| 77065 Dx mammo incl cad uni | $181 | $179 | +1% | 118 |
| 51720 Treatment of bladder lesion | $113 | $111 | +2% | 112 |
| 74176 Ct abd & pelvis w/o contrast | $292 | $287 | +2% | 118 |
| 52224 Cystoscopy and treatment | $467 | $459 | +2% | 112 |
| 76536 Us exam of head and neck | $157 | $154 | +2% | 118 |
| 74178 Ct abd&plv wo cntr flwd cntr | $520 | $511 | +2% | 220 |
| 76705 Echo exam of abdomen | $128 | $126 | +2% | 118 |
Frequently asked questions
How do commercial reimbursement rates in Massachusetts compare with the rest of the country?
Massachusetts ranks 13th of 51 states with an index of 123, across 228 procedure codes. Median commercial rates run 190% of the Medicare rate.
Which payer has the highest rates in Massachusetts?
In the files we analyzed, UnitedHealthcare has the highest index (137) and Aetna the lowest (62). 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 Massachusetts?
Internal medicine ranks 7th of 51 states.
How many providers does this Massachusetts page cover?
921 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 Massachusetts and the national median?
CPT 93298 (Rem interrog dev eval scrms) is highest relative to the nation at 239% of the national median; CPT 77080 (Dxa bone density axial) 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 Massachusetts contracts
Compare your negotiated rates with these state medians by payer and specialty.