Commercial healthcare reimbursement in Utah
How Utah compares with the nation, by payer, specialty and procedure.
Utah at a glance
What the data shows
Utah ranks 25th of 51 states for commercial reimbursement, with an index of 100 (100 = national median) across 228 procedure codes; the West region averages 118.
Commercial rates in Utah run a median 154% of Medicare.
UnitedHealthcare has the highest index in the state (111) and Aetna the lowest (90), a 20-point gap, in the files analyzed.
CPT 77280 (Ther rad simulaj field smpl) is the strongest relative to the national median (132% of it, a 32% premium); CPT 26055 (Incise finger tendon sheath) is furthest below (77% of the national median, 23% lower).
By specialty, Utah is strongest for cardiology (ranks 20th of 51 states for that specialty) and weakest for orthopedic surgery (38th of 51).
Against Medicare, gastroenterology has the highest ratio in Utah (191% of Medicare) and dermatology the lowest (98%).
Payer ranking in Utah
| Payer | Index | Rank | Level | Codes | Providers | TINs |
|---|---|---|---|---|---|---|
| UnitedHealthcare | 111 | 1 | 228 | 649 | 344 | |
| Blue Cross Blue Shield | 99 | 2 | 228 | 667 | 448 | |
| Cigna | 94 | 3 | 227 | 751 | 380 | |
| Aetna | 90 | 4 | 213 | 418 | 375 |
Reimbursement index by specialty in Utah
| Specialty | Index | Rank among states | % of Medicare | Level | Codes | Providers |
|---|---|---|---|---|---|---|
| Cardiology | 105 | 20 of 51 | 155% | 38 | 99 | |
| Gastroenterology | 102 | 22 of 50 | 191% | 36 | 88 | |
| Urology | 103 | 22 of 50 | 174% | 37 | 76 | |
| Ophthalmology | 102 | 23 of 50 | 121% | 42 | 116 | |
| Dermatology | 99 | 26 of 50 | 98% | 44 | 113 | |
| Internal medicine | 96 | 27 of 51 | 124% | 25 | 107 | |
| Diagnostic radiology | 94 | 33 of 51 | 150% | 49 | 122 | |
| Orthopedic surgery | 91 | 38 of 51 | 144% | 39 | 97 |
Specialty by payer in Utah
| Specialty | UHC | Aetna | Cigna | BCBS |
|---|---|---|---|---|
| Internal medicine | 124 | 73 | 104 | 101 |
| Dermatology | 116 | 79 | 104 | 89 |
| Ophthalmology | 88 | 88 | 105 | 100 |
| Cardiology | 120 | 92 | 97 | 118 |
| Orthopedic surgery | 104 | 84 | 86 | 88 |
| Diagnostic radiology | 116 | 82 | 86 | 98 |
| Urology | 125 | 109 | 97 | 95 |
| Gastroenterology | 129 | 133 | 90 | 83 |
Utah compared with West region states
| State | Index | Rank | % of Medicare | Providers | Level |
|---|---|---|---|---|---|
| Utah | 100 | 25 | 154% | 818 | |
| Montana | 100 | 24 | 160% | 448 | |
| Hawaii | 102 | 21 | 138% | 524 | |
| Colorado | 105 | 19 | 162% | 948 | |
| New Mexico | 94 | 33 | 141% | 622 | |
| California | 93 | 35 | 138% | 844 |
Procedures that pay most and least in Utah vs the nation
Highest vs national
| Code | Utah | National | Gap | Prov. |
|---|---|---|---|---|
| 77280 Ther rad simulaj field smpl | $398 | $302 | +32% | 113 |
| 76872 Us transrectal | $248 | $188 | +31% | 76 |
| 93297 Rem interrog dev eval icpms | $63 | $52 | +21% | 97 |
| 93298 Rem interrog dev eval scrms | $63 | $52 | +21% | 97 |
| 76856 Us exam pelvic complete | $178 | $148 | +20% | 76 |
| 75574 Ct angio hrt w/3d image | $585 | $495 | +18% | 98 |
| 93280 Pm device progr eval dual | $123 | $105 | +17% | 97 |
| 51798 Us urine capacity measure | $25 | $21 | +16% | 68 |
| 93229 Remote 30 day ecg tech supp | $1,253 | $1,088 | +15% | 93 |
| 52000 Cystourethroscopy | $241 | $210 | +15% | 76 |
| 76775 Us exam abdo back wall lim | $106 | $92 | +15% | 76 |
| 92134 Cptrz oph dx img pst sgm rta | $51 | $45 | +14% | 116 |
| 51720 Treatment of bladder lesion | $127 | $111 | +14% | 76 |
| 33208 Insrt heart pm atrial & vent | $929 | $819 | +13% | 97 |
| 51700 Irrigation of bladder | $87 | $77 | +13% | 76 |
Lowest vs national
| Code | Utah | National | Gap | Prov. |
|---|---|---|---|---|
| 26055 Incise finger tendon sheath | $475 | $614 | -23% | 97 |
| 43239 Egd biopsy single/multiple | $287 | $349 | -18% | 86 |
| 20550 Njx 1 tendon sheath/ligament | $61 | $74 | -17% | 97 |
| 20611 Drain/inj joint/bursa w/us | $96 | $117 | -17% | 96 |
| 99487 Cplx chrnc care 1st 60 min | $103 | $121 | -15% | 107 |
| 43235 Egd diagnostic brush wash | $255 | $294 | -13% | 86 |
| 76536 Us exam of head and neck | $136 | $154 | -12% | 121 |
| 29848 Wrist endoscopy/surgery | $724 | $817 | -11% | 97 |
| 27236 Treat thigh fracture | $1,702 | $1,918 | -11% | 96 |
| 70551 Mri brain stem w/o dye | $358 | $402 | -11% | 121 |
| 92012 Intrm oph exam est patient | $67 | $76 | -11% | 116 |
| 99213 Office o/p est low 20 min | $77 | $86 | -11% | 817 |
| 66821 After cataract laser surgery | $350 | $393 | -11% | 116 |
| 72141 Mri neck spine w/o dye | $348 | $390 | -11% | 121 |
| 67840 Remove eyelid lesion | $226 | $253 | -11% | 115 |
Frequently asked questions
How do commercial reimbursement rates in Utah compare with the rest of the country?
Utah ranks 25th 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 Utah?
In the files we analyzed, UnitedHealthcare has the highest index (111) and Aetna the lowest (90). 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 Utah?
Cardiology ranks 20th of 51 states.
How many providers does this Utah page cover?
818 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 Utah and the national median?
CPT 77280 (Ther rad simulaj field smpl) is highest relative to the nation at 132% of the national median; CPT 26055 (Incise finger tendon sheath) is lowest at 77%.
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 Utah contracts
Compare your negotiated rates with these state medians by payer and specialty.