Commercial healthcare reimbursement in New Jersey
How New Jersey compares with the nation, by payer, specialty and procedure.
New Jersey at a glance
What the data shows
New Jersey ranks 22nd of 51 states for commercial reimbursement, with an index of 100 (100 = national median) across 228 procedure codes; the Northeast region averages 107.
Commercial rates in New Jersey run a median 154% of Medicare.
UnitedHealthcare has the highest index in the state (109) and Aetna the lowest (82), a 27-point gap, in the files analyzed.
CPT 27130 (Total hip arthroplasty) is the strongest relative to the national median (134% of it, a 34% premium); CPT 96910 (Photchmtx tar&uvb/ptrltm&uvb) is furthest below (76% of the national median, 24% lower).
By specialty, New Jersey is strongest for urology (ranks 14th of 50 states for that specialty) and weakest for ophthalmology (46th of 50).
Against Medicare, gastroenterology has the highest ratio in New Jersey (194% of Medicare) and dermatology the lowest (83%).
Payer ranking in New Jersey
| Payer | Index | Rank | Level | Codes | Providers | TINs |
|---|---|---|---|---|---|---|
| UnitedHealthcare | 109 | 1 | 228 | 724 | 553 | |
| Cigna | 104 | 2 | 227 | 795 | 638 | |
| Blue Cross Blue Shield | 101 | 3 | 228 | 787 | 697 | |
| Aetna | 82 | 4 | 228 | 807 | 781 |
Reimbursement index by specialty in New Jersey
| Specialty | Index | Rank among states | % of Medicare | Level | Codes | Providers |
|---|---|---|---|---|---|---|
| Urology | 114 | 14 of 50 | 179% | 37 | 106 | |
| Orthopedic surgery | 114 | 14 of 51 | 169% | 39 | 96 | |
| Gastroenterology | 107 | 18 of 50 | 194% | 36 | 116 | |
| Diagnostic radiology | 102 | 21 of 51 | 156% | 49 | 126 | |
| Cardiology | 101 | 24 of 51 | 155% | 38 | 113 | |
| Internal medicine | 99 | 26 of 51 | 113% | 25 | 114 | |
| Dermatology | 83 | 45 of 50 | 83% | 44 | 99 | |
| Ophthalmology | 85 | 46 of 50 | 97% | 42 | 117 |
Specialty by payer in New Jersey
| Specialty | UHC | Aetna | Cigna | BCBS |
|---|---|---|---|---|
| Internal medicine | 103 | 69 | 97 | 108 |
| Dermatology | 97 | 64 | 85 | 99 |
| Ophthalmology | 74 | 80 | 67 | 83 |
| Cardiology | 116 | 83 | 102 | 100 |
| Orthopedic surgery | 144 | 114 | 119 | 135 |
| Diagnostic radiology | 112 | 82 | 119 | 87 |
| Urology | 158 | 80 | 129 | 119 |
| Gastroenterology | 130 | 82 | 110 | 108 |
New Jersey compared with Northeast region states
| State | Index | Rank | % of Medicare | Providers | Level |
|---|---|---|---|---|---|
| New Jersey | 100 | 22 | 154% | 887 | |
| Maine | 100 | 23 | 148% | 647 | |
| Rhode Island | 99 | 26 | 148% | 632 | |
| Pennsylvania | 96 | 30 | 143% | 892 | |
| Vermont | 107 | 18 | 157% | 365 | |
| New York | 93 | 37 | 132% | 942 |
Procedures that pay most and least in New Jersey vs the nation
Highest vs national
| Code | New Jersey | National | Gap | Prov. |
|---|---|---|---|---|
| 27130 Total hip arthroplasty | $2,885 | $2,158 | +34% | 95 |
| 23472 Reconstruct shoulder joint | $3,085 | $2,318 | +33% | 95 |
| 29827 Sho arthrs srg rt8tr cuf rpr | $2,246 | $1,701 | +32% | 95 |
| 27245 Treat thigh fracture | $2,629 | $1,994 | +32% | 95 |
| 27447 Total knee arthroplasty | $2,882 | $2,190 | +32% | 95 |
| 91110 Gi trc img intral esoph-ile | $1,532 | $1,175 | +30% | 116 |
| 22633 Arthrd cmbn 1ntrspc lumbar | $3,891 | $2,991 | +30% | 96 |
| 22551 Arthrd ant ntrbdy cervical | $3,606 | $2,778 | +30% | 94 |
| 27487 Revise/replace knee joint | $3,676 | $2,840 | +29% | 95 |
| 88313 Special stains group 2 | $90 | $71 | +28% | 116 |
| 27236 Treat thigh fracture | $2,446 | $1,918 | +27% | 96 |
| 22612 Arthrd pst tq 1ntrspc lumbar | $3,256 | $2,557 | +27% | 96 |
| 64721 Carpal tunnel surgery | $883 | $700 | +26% | 96 |
| 63047 Lam facetec & foramot lumbar | $2,238 | $1,796 | +25% | 95 |
| 22558 Arthrd ant ntrbd min dsc lum | $3,065 | $2,471 | +24% | 95 |
Lowest vs national
| Code | New Jersey | National | Gap | Prov. |
|---|---|---|---|---|
| 96910 Photchmtx tar&uvb/ptrltm&uvb | $95 | $125 | -24% | 99 |
| 67904 Repair eyelid defect | $629 | $816 | -23% | 117 |
| 66821 After cataract laser surgery | $304 | $393 | -23% | 117 |
| 67028 Injection eye drug | $106 | $137 | -22% | 117 |
| 15823 Blepharp upr eyelid xcsv skn | $533 | $677 | -21% | 117 |
| 67210 Treatment of retinal lesion | $519 | $659 | -21% | 117 |
| 15260 Fth/gft fr n/e/e/l 20 sqcm/< | $854 | $1,078 | -21% | 99 |
| 67036 Removal of inner eye fluid | $887 | $1,117 | -21% | 117 |
| 65756 Corneal trnspl endothelial | $1,137 | $1,425 | -20% | 117 |
| 11301 Shave skin lesion 0.6-1.0 cm | $68 | $85 | -20% | 99 |
| 17004 Destroy premal lesions 15/> | $123 | $154 | -20% | 99 |
| 67108 Repair detached retina | $1,276 | $1,594 | -20% | 117 |
| 14061 Tis trnfr e/n/e/l10.1-30sqcm | $860 | $1,074 | -20% | 99 |
| 68761 Close tear duct opening | $131 | $164 | -20% | 117 |
| 65820 Goniotomy | $766 | $955 | -20% | 117 |
Frequently asked questions
How do commercial reimbursement rates in New Jersey compare with the rest of the country?
New Jersey ranks 22nd of 51 states with an index of 100, across 228 procedure codes. Median commercial rates run 154% of the Medicare rate.
Which payer has the highest rates in New Jersey?
In the files we analyzed, UnitedHealthcare has the highest index (109) 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 New Jersey?
Urology ranks 14th of 50 states.
How many providers does this New Jersey page cover?
887 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 New Jersey and the national median?
CPT 27130 (Total hip arthroplasty) is highest relative to the nation at 134% of the national median; CPT 96910 (Photchmtx tar&uvb/ptrltm&uvb) is lowest at 76%.
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 New Jersey contracts
Compare your negotiated rates with these state medians by payer and specialty.