Commercial healthcare reimbursement in Washington
How Washington compares with the nation, by payer, specialty and procedure.
Washington at a glance
What the data shows
Washington ranks 7th of 51 states for commercial reimbursement, with an index of 133 (100 = national median) across 228 procedure codes; the West region averages 118.
Commercial rates in Washington run a median 212% of Medicare.
UnitedHealthcare has the highest index in the state (106) and Aetna the lowest (91), a 15-point gap, in the files analyzed.
CPT 11102 (Tangntl bx skin single les) is the strongest relative to the national median (173% of it, a 73% premium); CPT 76512 (Oph us dx b-scan) is furthest below (94% of the national median, 6% lower).
By specialty, Washington is strongest for diagnostic radiology (ranks 2nd of 51 states for that specialty) and weakest for ophthalmology (14th of 50).
Against Medicare, gastroenterology has the highest ratio in Washington (244% of Medicare) and dermatology the lowest (139%).
Payer ranking in Washington
| Payer | Index | Rank | Level | Codes | Providers | TINs |
|---|---|---|---|---|---|---|
| UnitedHealthcare | 106 | 1 | 228 | 695 | 377 | |
| Cigna | 99 | 2 | 227 | 749 | 412 | |
| Blue Cross Blue Shield | 98 | 3 | 228 | 799 | 696 | |
| Aetna | 91 | 4 | 228 | 708 | 426 |
Reimbursement index by specialty in Washington
| Specialty | Index | Rank among states | % of Medicare | Level | Codes | Providers |
|---|---|---|---|---|---|---|
| Diagnostic radiology | 143 | 2 of 51 | 225% | 49 | 117 | |
| Urology | 134 | 4 of 50 | 220% | 37 | 111 | |
| Internal medicine | 150 | 5 of 51 | 166% | 25 | 110 | |
| Cardiology | 139 | 5 of 51 | 209% | 38 | 110 | |
| Orthopedic surgery | 133 | 6 of 51 | 193% | 39 | 101 | |
| Gastroenterology | 134 | 8 of 50 | 244% | 36 | 97 | |
| Dermatology | 143 | 10 of 50 | 139% | 44 | 107 | |
| Ophthalmology | 122 | 14 of 50 | 140% | 42 | 120 |
Specialty by payer in Washington
| Specialty | UHC | Aetna | Cigna | BCBS |
|---|---|---|---|---|
| Internal medicine | 193 | 130 | 149 | 151 |
| Dermatology | 190 | 102 | 130 | 146 |
| Ophthalmology | 128 | 112 | 98 | 121 |
| Cardiology | 148 | 138 | 138 | 132 |
| Orthopedic surgery | 143 | 125 | 133 | 126 |
| Diagnostic radiology | 150 | 144 | 153 | 134 |
| Urology | 170 | 125 | 132 | 138 |
| Gastroenterology | 176 | 120 | 124 | 134 |
Washington compared with West region states
Procedures that pay most and least in Washington vs the nation
Highest vs national
| Code | Washington | National | Gap | Prov. |
|---|---|---|---|---|
| 11102 Tangntl bx skin single les | $112 | $65 | +73% | 107 |
| 11104 Punch bx skin single lesion | $139 | $81 | +72% | 107 |
| 11301 Shave skin lesion 0.6-1.0 cm | $141 | $85 | +67% | 107 |
| 11302 Shave skin lesion 1.1-2.0 cm | $163 | $98 | +65% | 107 |
| 90960 Esrd srv 4 visits p mo 20+ | $742 | $453 | +64% | 109 |
| 99490 Chrnc care mgmt staff 1st 20 | $97 | $60 | +61% | 423 |
| 93297 Rem interrog dev eval icpms | $83 | $52 | +58% | 109 |
| 99487 Cplx chrnc care 1st 60 min | $191 | $121 | +57% | 109 |
| 99215 Office o/p est hi 40 min | $276 | $176 | +57% | 868 |
| 76872 Us transrectal | $295 | $188 | +56% | 111 |
| 76641 Ultrasound breast complete | $227 | $145 | +56% | 117 |
| 17313 Mohs 1 stage t/a/l | $797 | $515 | +55% | 106 |
| 77066 Dx mammo incl cad bi | $348 | $225 | +55% | 117 |
| 77065 Dx mammo incl cad uni | $276 | $179 | +54% | 117 |
| 77067 Scr mammo bi incl cad | $281 | $182 | +54% | 117 |
Lowest vs national
| Code | Washington | National | Gap | Prov. |
|---|---|---|---|---|
| 76512 Oph us dx b-scan | $66 | $70 | -6% | 120 |
| 64566 Neuroeltrd stim post tibial | $75 | $69 | +8% | 111 |
| 65855 Trabeculoplasty laser surg | $332 | $307 | +8% | 120 |
| 51720 Treatment of bladder lesion | $122 | $111 | +9% | 111 |
| 66984 Xcapsl ctrc rmvl w/o ecp | $818 | $738 | +11% | 120 |
| 67028 Injection eye drug | $152 | $137 | +11% | 120 |
| 67108 Repair detached retina | $1,779 | $1,594 | +12% | 120 |
| 72148 Mri lumbar spine w/o dye | $429 | $382 | +12% | 217 |
| 51798 Us urine capacity measure | $24 | $21 | +13% | 99 |
| 55866 Laps surg prst8ect rpbic rad | $2,522 | $2,237 | +13% | 111 |
| 65778 Cover eye w/membrane | $79 | $70 | +13% | 118 |
| 73221 Mri joint upr extrem w/o dye | $454 | $399 | +14% | 217 |
| 67210 Treatment of retinal lesion | $752 | $659 | +14% | 120 |
| 66982 Xcapsl ctrc rmvl cplx wo ecp | $1,120 | $981 | +14% | 120 |
| 67042 Vit for macular hole | $1,711 | $1,494 | +15% | 120 |
Frequently asked questions
How do commercial reimbursement rates in Washington compare with the rest of the country?
Washington ranks 7th of 51 states with an index of 133, across 228 procedure codes. Median commercial rates run 212% of the Medicare rate.
Which payer has the highest rates in Washington?
In the files we analyzed, UnitedHealthcare has the highest index (106) and Aetna the lowest (91). 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 Washington?
Diagnostic radiology ranks 2nd of 51 states.
How many providers does this Washington page cover?
873 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 Washington and the national median?
CPT 11102 (Tangntl bx skin single les) is highest relative to the nation at 173% of the national median; CPT 76512 (Oph us dx b-scan) is lowest at 94%.
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 Washington contracts
Compare your negotiated rates with these state medians by payer and specialty.