Commercial healthcare reimbursement in Rhode Island
How Rhode Island compares with the nation, by payer, specialty and procedure.
Rhode Island at a glance
What the data shows
Rhode Island ranks 26th of 51 states for commercial reimbursement, with an index of 99 (100 = national median) across 228 procedure codes; the Northeast region averages 107.
Commercial rates in Rhode Island run a median 148% of Medicare.
UnitedHealthcare has the highest index in the state (129) and Aetna the lowest (87), a 42-point gap, in the files analyzed.
CPT 75574 (Ct angio hrt w/3d image) is the strongest relative to the national median (128% of it, a 28% premium); CPT 51798 (Us urine capacity measure) is furthest below (73% of the national median, 27% lower).
By specialty, Rhode Island is strongest for cardiology (ranks 17th of 51 states for that specialty) and weakest for gastroenterology (42nd of 50).
Against Medicare, gastroenterology has the highest ratio in Rhode Island (164% of Medicare) and dermatology the lowest (103%).
Payer ranking in Rhode Island
| Payer | Index | Rank | Level | Codes | Providers | TINs |
|---|---|---|---|---|---|---|
| UnitedHealthcare | 129 | 1 | 228 | 468 | 257 | |
| Cigna | 110 | 2 | 227 | 562 | 310 | |
| Blue Cross Blue Shield | 90 | 3 | 228 | 581 | 364 | |
| Aetna | 87 | 4 | 227 | 422 | 321 |
Reimbursement index by specialty in Rhode Island
| Specialty | Index | Rank among states | % of Medicare | Level | Codes | Providers |
|---|---|---|---|---|---|---|
| Cardiology | 107 | 17 of 51 | 160% | 38 | 91 | |
| Dermatology | 105 | 21 of 50 | 103% | 44 | 48 | |
| Ophthalmology | 98 | 25 of 50 | 122% | 42 | 62 | |
| Orthopedic surgery | 100 | 25 of 51 | 138% | 39 | 98 | |
| Diagnostic radiology | 98 | 30 of 51 | 148% | 49 | 128 | |
| Urology | 93 | 33 of 50 | 152% | 37 | 41 | |
| Internal medicine | 91 | 34 of 51 | 104% | 25 | 98 | |
| Gastroenterology | 87 | 42 of 50 | 164% | 36 | 66 |
Specialty by payer in Rhode Island
| Specialty | UHC | Aetna | Cigna | BCBS |
|---|---|---|---|---|
| Internal medicine | 118 | 78 | 94 | 82 |
| Dermatology | 147 | 85 | 123 | 96 |
| Ophthalmology | 78 | 103 | 94 | 89 |
| Cardiology | 119 | 84 | 104 | 95 |
| Orthopedic surgery | 140 | 81 | 110 | 98 |
| Diagnostic radiology | 108 | 89 | 108 | 86 |
| Urology | 133 | 80 | 98 | 77 |
| Gastroenterology | 103 | 83 | 93 | 70 |
Rhode Island compared with Northeast region states
| State | Index | Rank | % of Medicare | Providers | Level |
|---|---|---|---|---|---|
| Rhode Island | 99 | 26 | 148% | 632 | |
| New Jersey | 100 | 22 | 154% | 887 | |
| Maine | 100 | 23 | 148% | 647 | |
| Pennsylvania | 96 | 30 | 143% | 892 | |
| New York | 93 | 37 | 132% | 942 | |
| Vermont | 107 | 18 | 157% | 365 |
Procedures that pay most and least in Rhode Island vs the nation
Highest vs national
| Code | Rhode Island | National | Gap | Prov. |
|---|---|---|---|---|
| 75574 Ct angio hrt w/3d image | $634 | $495 | +28% | 91 |
| 93656 Compre ep eval abltj atr fib | $2,010 | $1,615 | +24% | 91 |
| 65778 Cover eye w/membrane | $86 | $70 | +24% | 62 |
| 92928 Prq tcat plmt ntrac st 1 les | $1,055 | $887 | +19% | 91 |
| 88342 Imhchem/imcytchm 1st antb | $113 | $95 | +18% | 48 |
| 93010 Electrocardiogram report | $15 | $13 | +18% | 91 |
| 93296 Rem interrog evl pm/ids | $45 | $39 | +16% | 91 |
| 93306 Tte w/doppler complete | $367 | $318 | +15% | 188 |
| 93229 Remote 30 day ecg tech supp | $1,249 | $1,088 | +15% | 91 |
| 93294 Rem interrog evl pm/ldls pm | $55 | $48 | +15% | 91 |
| 93016 Cv stress test supvj only | $39 | $34 | +14% | 91 |
| 12042 Intmd rpr n-hf/genit2.6-7.5 | $323 | $285 | +13% | 48 |
| 93351 Stress tte complete | $415 | $366 | +13% | 91 |
| 71271 Ct thorax lung cancer scr c- | $236 | $208 | +13% | 126 |
| 93308 Tte f-up or lmtd | $175 | $155 | +13% | 91 |
Lowest vs national
| Code | Rhode Island | National | Gap | Prov. |
|---|---|---|---|---|
| 51798 Us urine capacity measure | $16 | $21 | -27% | 39 |
| 43248 Egd guide wire insertion | $266 | $364 | -27% | 66 |
| 43251 Egd remove lesion snare | $314 | $425 | -26% | 66 |
| 45378 Diagnostic colonoscopy | $321 | $408 | -21% | 66 |
| 43239 Egd biopsy single/multiple | $276 | $349 | -21% | 66 |
| 99348 Home/res vst est low mdm 30 | $87 | $109 | -20% | 97 |
| 99426 Prin care mgmt staff 1st 30 | $63 | $77 | -18% | 40 |
| 52000 Cystourethroscopy | $173 | $210 | -18% | 41 |
| 45380 Colonoscopy and biopsy | $388 | $470 | -18% | 66 |
| 99349 Home/res vst est mod mdm 40 | $144 | $174 | -17% | 97 |
| 43255 Egd control bleeding any | $381 | $459 | -17% | 66 |
| 93880 Extracranial bilat study | $235 | $283 | -17% | 314 |
| 45388 Colonoscopy w/ablation | $409 | $492 | -17% | 66 |
| 92012 Intrm oph exam est patient | $63 | $76 | -17% | 62 |
| 99497 Advncd care plan 30 min | $91 | $108 | -16% | 97 |
Frequently asked questions
How do commercial reimbursement rates in Rhode Island compare with the rest of the country?
Rhode Island ranks 26th of 51 states with an index of 99, across 228 procedure codes. Median commercial rates run 148% of the Medicare rate.
Which payer has the highest rates in Rhode Island?
In the files we analyzed, UnitedHealthcare has the highest index (129) and Aetna the lowest (87). 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 Rhode Island?
Cardiology ranks 17th of 51 states.
How many providers does this Rhode Island page cover?
632 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 Rhode Island and the national median?
CPT 75574 (Ct angio hrt w/3d image) is highest relative to the nation at 128% of the national median; CPT 51798 (Us urine capacity measure) is lowest at 73%.
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 Rhode Island contracts
Compare your negotiated rates with these state medians by payer and specialty.