Commercial healthcare reimbursement in New York
How New York compares with the nation, by payer, specialty and procedure.
New York at a glance
What the data shows
New York ranks 37th of 51 states for commercial reimbursement, with an index of 93 (100 = national median) across 228 procedure codes; the Northeast region averages 107.
Commercial rates in New York run a median 132% of Medicare.
UnitedHealthcare has the highest index in the state (128) and Aetna the lowest (83), a 45-point gap, in the files analyzed.
CPT 64566 (Neuroeltrd stim post tibial) is the strongest relative to the national median (158% of it, a 58% premium); CPT 75574 (Ct angio hrt w/3d image) is furthest below (74% of the national median, 26% lower).
By specialty, New York is strongest for dermatology (ranks 22nd of 50 states for that specialty) and weakest for diagnostic radiology (48th of 51).
Against Medicare, gastroenterology has the highest ratio in New York (156% of Medicare) and dermatology the lowest (103%).
Payer ranking in New York
| Payer | Index | Rank | Level | Codes | Providers | TINs |
|---|---|---|---|---|---|---|
| UnitedHealthcare | 128 | 1 | 228 | 801 | 665 | |
| Cigna | 120 | 2 | 228 | 672 | 533 | |
| Blue Cross Blue Shield | 97 | 3 | 228 | 898 | 822 | |
| Aetna | 83 | 4 | 228 | 755 | 744 |
Reimbursement index by specialty in New York
| Specialty | Index | Rank among states | % of Medicare | Level | Codes | Providers |
|---|---|---|---|---|---|---|
| Dermatology | 102 | 22 of 50 | 103% | 44 | 107 | |
| Urology | 102 | 23 of 50 | 155% | 37 | 116 | |
| Gastroenterology | 98 | 25 of 50 | 156% | 36 | 131 | |
| Orthopedic surgery | 96 | 29 of 51 | 141% | 39 | 111 | |
| Internal medicine | 94 | 32 of 51 | 107% | 25 | 115 | |
| Ophthalmology | 92 | 34 of 50 | 109% | 42 | 110 | |
| Cardiology | 88 | 43 of 51 | 126% | 38 | 123 | |
| Diagnostic radiology | 83 | 48 of 51 | 131% | 49 | 129 |
Specialty by payer in New York
| Specialty | UHC | Aetna | Cigna | BCBS |
|---|---|---|---|---|
| Internal medicine | 133 | 65 | 98 | 90 |
| Dermatology | 131 | 85 | 103 | 103 |
| Ophthalmology | 94 | 91 | 85 | 95 |
| Cardiology | 124 | 67 | 133 | 79 |
| Orthopedic surgery | 128 | 72 | 149 | 76 |
| Diagnostic radiology | 110 | 72 | 126 | 76 |
| Urology | 130 | 73 | 122 | 85 |
| Gastroenterology | 119 | 72 | 104 | 95 |
New York compared with Northeast region states
| State | Index | Rank | % of Medicare | Providers | Level |
|---|---|---|---|---|---|
| New York | 93 | 37 | 132% | 942 | |
| Pennsylvania | 96 | 30 | 143% | 892 | |
| Rhode Island | 99 | 26 | 148% | 632 | |
| New Jersey | 100 | 22 | 154% | 887 | |
| Maine | 100 | 23 | 148% | 647 | |
| Vermont | 107 | 18 | 157% | 365 |
Procedures that pay most and least in New York vs the nation
Highest vs national
| Code | New York | National | Gap | Prov. |
|---|---|---|---|---|
| 64566 Neuroeltrd stim post tibial | $110 | $69 | +58% | 113 |
| 52224 Cystoscopy and treatment | $698 | $459 | +52% | 113 |
| 11104 Punch bx skin single lesion | $116 | $81 | +43% | 107 |
| 11102 Tangntl bx skin single les | $92 | $65 | +41% | 107 |
| 43249 Esoph egd dilation <30 mm | $372 | $271 | +37% | 130 |
| 11301 Shave skin lesion 0.6-1.0 cm | $110 | $85 | +30% | 107 |
| 43255 Egd control bleeding any | $594 | $459 | +30% | 130 |
| 11302 Shave skin lesion 1.1-2.0 cm | $124 | $98 | +27% | 107 |
| 52648 Laser surgery of prostate | $1,884 | $1,508 | +25% | 114 |
| 17313 Mohs 1 stage t/a/l | $617 | $515 | +20% | 107 |
| 77280 Ther rad simulaj field smpl | $354 | $302 | +17% | 106 |
| 51702 Insert temp bladder cath | $71 | $61 | +16% | 114 |
| 43251 Egd remove lesion snare | $492 | $425 | +16% | 131 |
| 17311 Mohs 1 stage h/n/hf/g | $658 | $577 | +14% | 107 |
| 51700 Irrigation of bladder | $88 | $77 | +14% | 114 |
Lowest vs national
| Code | New York | National | Gap | Prov. |
|---|---|---|---|---|
| 75574 Ct angio hrt w/3d image | $364 | $495 | -26% | 121 |
| 93294 Rem interrog evl pm/ldls pm | $35 | $48 | -26% | 123 |
| 72158 Mri lumbar spine w/o & w/dye | $447 | $593 | -25% | 128 |
| 70553 Mri brain stem w/o & w/dye | $453 | $600 | -25% | 128 |
| 71046 X-ray exam chest 2 views | $34 | $45 | -24% | 128 |
| 93296 Rem interrog evl pm/ids | $30 | $39 | -24% | 122 |
| 72125 Ct neck spine w/o dye | $191 | $249 | -23% | 128 |
| 72197 Mri pelvis w/o & w/dye | $491 | $634 | -23% | 128 |
| 93010 Electrocardiogram report | $10 | $13 | -22% | 123 |
| 72131 Ct lumbar spine w/o dye | $193 | $248 | -22% | 128 |
| 74183 Mri abd w/o cntr flwd cntr | $493 | $634 | -22% | 128 |
| 71250 Ct thorax dx c- | $195 | $250 | -22% | 128 |
| 93015 Cv stress test supvj i&r | $94 | $120 | -22% | 122 |
| 71260 Ct thorax dx c+ | $247 | $312 | -21% | 128 |
| 70450 Ct head/brain w/o dye | $154 | $194 | -21% | 128 |
Frequently asked questions
How do commercial reimbursement rates in New York compare with the rest of the country?
New York ranks 37th of 51 states with an index of 93, across 228 procedure codes. Median commercial rates run 132% of the Medicare rate.
Which payer has the highest rates in New York?
In the files we analyzed, UnitedHealthcare has the highest index (128) and Aetna the lowest (83). 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 York?
Dermatology ranks 22nd of 50 states.
How many providers does this New York page cover?
942 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 York and the national median?
CPT 64566 (Neuroeltrd stim post tibial) is highest relative to the nation at 158% of the national median; CPT 75574 (Ct angio hrt w/3d image) is lowest at 74%.
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 York contracts
Compare your negotiated rates with these state medians by payer and specialty.