Commercial healthcare reimbursement in Missouri
How Missouri compares with the nation, by payer, specialty and procedure.
Missouri at a glance
What the data shows
Missouri ranks 32nd of 51 states for commercial reimbursement, with an index of 94 (100 = national median) across 228 procedure codes; the Midwest region averages 115.
Commercial rates in Missouri run a median 146% of Medicare.
UnitedHealthcare has the highest index in the state (112) and Aetna the lowest (82), a 30-point gap, in the files analyzed.
CPT 43255 (Egd control bleeding any) is the strongest relative to the national median (115% of it, a 15% premium); CPT 72110 (X-ray exam l-2 spine 4/>vws) is furthest below (82% of the national median, 18% lower).
By specialty, Missouri is strongest for cardiology (ranks 25th of 51 states for that specialty) and weakest for orthopedic surgery (45th of 51).
Against Medicare, gastroenterology has the highest ratio in Missouri (172% of Medicare) and dermatology the lowest (94%).
Payer ranking in Missouri
| Payer | Index | Rank | Level | Codes | Providers | TINs |
|---|---|---|---|---|---|---|
| UnitedHealthcare | 112 | 1 | 228 | 821 | 546 | |
| Blue Cross Blue Shield | 100 | 2 | 228 | 902 | 826 | |
| Cigna | 96 | 3 | 228 | 849 | 569 | |
| Aetna | 82 | 4 | 228 | 630 | 463 |
Reimbursement index by specialty in Missouri
| Specialty | Index | Rank among states | % of Medicare | Level | Codes | Providers |
|---|---|---|---|---|---|---|
| Cardiology | 100 | 25 of 51 | 149% | 38 | 120 | |
| Diagnostic radiology | 99 | 27 of 51 | 162% | 49 | 124 | |
| Gastroenterology | 96 | 28 of 50 | 172% | 36 | 135 | |
| Dermatology | 94 | 33 of 50 | 94% | 44 | 118 | |
| Urology | 92 | 34 of 50 | 154% | 37 | 119 | |
| Ophthalmology | 90 | 36 of 50 | 106% | 42 | 110 | |
| Internal medicine | 89 | 36 of 51 | 110% | 25 | 114 | |
| Orthopedic surgery | 86 | 45 of 51 | 121% | 39 | 112 |
Specialty by payer in Missouri
| Specialty | UHC | Aetna | Cigna | BCBS |
|---|---|---|---|---|
| Internal medicine | 98 | 65 | 88 | 84 |
| Dermatology | 106 | 67 | 82 | 94 |
| Ophthalmology | 100 | 76 | 84 | 92 |
| Cardiology | 117 | 89 | 105 | 91 |
| Orthopedic surgery | 94 | 74 | 85 | 85 |
| Diagnostic radiology | 111 | 94 | 101 | 100 |
| Urology | 112 | 68 | 94 | 88 |
| Gastroenterology | 118 | 68 | 86 | 96 |
Missouri compared with Midwest region states
Procedures that pay most and least in Missouri vs the nation
Highest vs national
| Code | Missouri | National | Gap | Prov. |
|---|---|---|---|---|
| 43255 Egd control bleeding any | $529 | $459 | +15% | 135 |
| 74177 Ct abd & pelvis w/contrast | $489 | $448 | +9% | 123 |
| 76700 Us exam abdom complete | $182 | $168 | +8% | 124 |
| 11302 Shave skin lesion 1.1-2.0 cm | $106 | $98 | +8% | 118 |
| 93280 Pm device progr eval dual | $113 | $105 | +7% | 120 |
| 74176 Ct abd & pelvis w/o contrast | $308 | $287 | +7% | 123 |
| 93015 Cv stress test supvj i&r | $129 | $120 | +7% | 120 |
| 51702 Insert temp bladder cath | $65 | $61 | +7% | 118 |
| 93458 L hrt artery/ventricle angio | $1,683 | $1,573 | +7% | 119 |
| 76705 Echo exam of abdomen | $135 | $126 | +7% | 124 |
| 71045 X-ray exam chest 1 view | $35 | $33 | +7% | 122 |
| 33208 Insrt heart pm atrial & vent | $871 | $819 | +6% | 120 |
| 43251 Egd remove lesion snare | $451 | $425 | +6% | 135 |
| 93010 Electrocardiogram report | $13 | $13 | +5% | 120 |
| 43248 Egd guide wire insertion | $383 | $364 | +5% | 135 |
Lowest vs national
| Code | Missouri | National | Gap | Prov. |
|---|---|---|---|---|
| 72110 X-ray exam l-2 spine 4/>vws | $58 | $71 | -18% | 112 |
| 22551 Arthrd ant ntrbdy cervical | $2,291 | $2,778 | -18% | 112 |
| 26055 Incise finger tendon sheath | $508 | $614 | -17% | 112 |
| 92012 Intrm oph exam est patient | $63 | $76 | -17% | 110 |
| 72100 X-ray exam l-s spine 2/3 vws | $44 | $53 | -17% | 112 |
| 22633 Arthrd cmbn 1ntrspc lumbar | $2,496 | $2,991 | -17% | 112 |
| 73630 X-ray exam of foot | $37 | $44 | -17% | 112 |
| 64721 Carpal tunnel surgery | $586 | $700 | -16% | 112 |
| 73560 X-ray exam of knee 1 or 2 | $38 | $45 | -16% | 112 |
| 64566 Neuroeltrd stim post tibial | $58 | $69 | -16% | 118 |
| 76512 Oph us dx b-scan | $59 | $70 | -16% | 110 |
| 72148 Mri lumbar spine w/o dye | $323 | $382 | -16% | 236 |
| 73721 Mri jnt of lwr extre w/o dye | $337 | $399 | -15% | 236 |
| 67840 Remove eyelid lesion | $214 | $253 | -15% | 110 |
| 73221 Mri joint upr extrem w/o dye | $339 | $399 | -15% | 236 |
Frequently asked questions
How do commercial reimbursement rates in Missouri compare with the rest of the country?
Missouri ranks 32nd of 51 states with an index of 94, across 228 procedure codes. Median commercial rates run 146% of the Medicare rate.
Which payer has the highest rates in Missouri?
In the files we analyzed, UnitedHealthcare has the highest index (112) 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 Missouri?
Cardiology ranks 25th of 51 states.
How many providers does this Missouri page cover?
952 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 Missouri and the national median?
CPT 43255 (Egd control bleeding any) is highest relative to the nation at 115% of the national median; CPT 72110 (X-ray exam l-2 spine 4/>vws) is lowest at 82%.
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 Missouri contracts
Compare your negotiated rates with these state medians by payer and specialty.