Virginia · state market

Commercial healthcare reimbursement in Virginia

How Virginia compares with the nation, by payer, specialty and procedure.

State indexSnapshot Aug 2026

Virginia at a glance

228 procedure codes, 8 specialties

Index vs national

9% below the national median

State rank

39 of 51

1 = highest

Median % of Medicare

139%

across tracked codes

Payers

907 sampled providers

What the data shows

Generated from this state's numbers

Virginia ranks 39th of 51 states for commercial reimbursement, with an index of 91 (100 = national median) across 228 procedure codes; the South region averages 94.

Commercial rates in Virginia run a median 139% of Medicare.

UnitedHealthcare has the highest index in the state (116) and Blue Cross Blue Shield the lowest (87), a 28-point gap, in the files analyzed.

CPT 96413 (Chemo iv infusion 1 hr) is the strongest relative to the national median (107% of it, a 7% premium); CPT 88312 (Special stains group 1) is furthest below (69% of the national median, 31% lower).

By specialty, Virginia is strongest for diagnostic radiology (ranks 25th of 51 states for that specialty) and weakest for cardiology (45th of 51).

Against Medicare, gastroenterology has the highest ratio in Virginia (163% of Medicare) and dermatology the lowest (83%).

Payer ranking in Virginia

Index: 100 = the four-payer state median; counts are sampled providers and TINs

Payer	Index	Rank	Codes	Providers	TINs
UnitedHealthcare	116	1	228	733	542
Cigna	102	2	227	787	614
Aetna	93	3	228	752	572
Blue Cross Blue Shield	87	4	228	813	831

Reimbursement index by specialty in Virginia

100 = the specialty's national median; the Medicare column compares median rates with the CY2026 Medicare rate

Specialty	Index	Rank among states	% of Medicare	Codes	Providers
Diagnostic radiology	100	25 of 51	151%	49	123
Urology	96	30 of 50	161%	37	109
Orthopedic surgery	94	33 of 51	135%	39	105
Gastroenterology	91	38 of 50	163%	36	118
Internal medicine	86	39 of 51	97%	25	99
Dermatology	85	42 of 50	83%	44	121
Ophthalmology	86	42 of 50	104%	42	109
Cardiology	87	45 of 51	131%	38	123

Specialty by payer in Virginia

Index: 100 = the specialty's national median for the same codes; bold = highest payer for that specialty; n/a = fewer than 10 codes with enough data

Specialty	UHC	Aetna	Cigna	BCBS
Internal medicine	111	69	90	82
Dermatology	106	79	80	77
Ophthalmology	92	91	78	85
Cardiology	104	72	96	75
Orthopedic surgery	112	92	101	84
Diagnostic radiology	112	91	116	79
Urology	124	79	92	78
Gastroenterology	112	84	94	67

Virginia compared with South region states

Closest states in the South region by index; the region averages 94

State	Index	Rank	% of Medicare	Providers
Virginia	91	39	139%	907
South Carolina	92	38	140%	872
Arkansas	93	36	144%	788
West Virginia	93	34	146%	608
Louisiana	89	41	132%	917
Kentucky	88	42	133%	977

Procedures that pay most and least in Virginia vs the nation

Median across payers; the 15 largest gaps in each direction

Highest vs national

Code	Virginia	National	Gap	Prov.
96413 Chemo iv infusion 1 hr	$219	$204	+7%	115
72148 Mri lumbar spine w/o dye	$405	$382	+6%	223
73221 Mri joint upr extrem w/o dye	$422	$399	+6%	223
73721 Mri jnt of lwr extre w/o dye	$422	$399	+6%	223
51798 Us urine capacity measure	$22	$21	+5%	101
92242 Fluorescein&icg angiography	$298	$288	+4%	105
76641 Ultrasound breast complete	$150	$145	+3%	119
72141 Mri neck spine w/o dye	$400	$390	+3%	120
76872 Us transrectal	$193	$188	+3%	104
74178 Ct abd&plv wo cntr flwd cntr	$522	$511	+2%	224
76770 Us exam abdo back wall comp	$159	$156	+2%	226
76642 Ultrasound breast limited	$123	$120	+2%	120
77066 Dx mammo incl cad bi	$229	$225	+2%	120
43235 Egd diagnostic brush wash	$298	$294	+1%	118
72197 Mri pelvis w/o & w/dye	$641	$634	+1%	120

Lowest vs national

Code	Virginia	National	Gap	Prov.
88312 Special stains group 1	$67	$97	-31%	236
88342 Imhchem/imcytchm 1st antb	$69	$95	-27%	120
11104 Punch bx skin single lesion	$61	$81	-25%	121
11102 Tangntl bx skin single les	$49	$65	-25%	121
11301 Shave skin lesion 0.6-1.0 cm	$64	$85	-24%	121
76512 Oph us dx b-scan	$53	$70	-24%	107
67028 Injection eye drug	$107	$137	-22%	108
11302 Shave skin lesion 1.1-2.0 cm	$77	$98	-22%	121
17311 Mohs 1 stage h/n/hf/g	$453	$577	-21%	121
65778 Cover eye w/membrane	$55	$70	-21%	104
67840 Remove eyelid lesion	$200	$253	-21%	108
17313 Mohs 1 stage t/a/l	$406	$515	-21%	121
96372 Ther/proph/diag inj sc/im	$19	$24	-21%	98
65855 Trabeculoplasty laser surg	$247	$307	-20%	108
36465 Njx noncmpnd sclrsnt 1 vein	$150	$185	-19%	123

Frequently asked questions

Answers use this page's data

How do commercial reimbursement rates in Virginia compare with the rest of the country?

Virginia ranks 39th of 51 states with an index of 91, across 228 procedure codes. Median commercial rates run 139% of the Medicare rate.

Which payer has the highest rates in Virginia?

In the files we analyzed, UnitedHealthcare has the highest index (116) and Blue Cross Blue Shield 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 Virginia?

Diagnostic radiology ranks 25th of 51 states.

How many providers does this Virginia page cover?

907 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 Virginia and the national median?

CPT 96413 (Chemo iv infusion 1 hr) is highest relative to the nation at 107% of the national median; CPT 88312 (Special stains group 1) is lowest at 69%.

Methodology

How these numbers are calculated

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.

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