Commercial healthcare reimbursement in West Virginia
How West Virginia compares with the nation, by payer, specialty and procedure.
West Virginia at a glance
What the data shows
West Virginia ranks 34th of 51 states for commercial reimbursement, with an index of 93 (100 = national median) across 228 procedure codes; the South region averages 94.
Commercial rates in West Virginia run a median 146% of Medicare.
UnitedHealthcare has the highest index in the state (130) and Aetna the lowest (76), a 54-point gap, in the files analyzed.
CPT 11104 (Punch bx skin single lesion) is the strongest relative to the national median (132% of it, a 32% premium); CPT 88342 (Imhchem/imcytchm 1st antb) is furthest below (72% of the national median, 28% lower).
By specialty, West Virginia is strongest for diagnostic radiology (ranks 22nd of 51 states for that specialty) and weakest for gastroenterology (44th of 50).
Against Medicare, gastroenterology has the highest ratio in West Virginia (169% of Medicare) and dermatology the lowest (102%).
Payer ranking in West Virginia
| Payer | Index | Rank | Level | Codes | Providers | TINs |
|---|---|---|---|---|---|---|
| UnitedHealthcare | 130 | 1 | 228 | 512 | 324 | |
| Cigna | 110 | 2 | 227 | 518 | 296 | |
| Blue Cross Blue Shield | 78 | 3 | 194 | 292 | 307 | |
| Aetna | 76 | 4 | 193 | 329 | 264 |
Reimbursement index by specialty in West Virginia
| Specialty | Index | Rank among states | % of Medicare | Level | Codes | Providers |
|---|---|---|---|---|---|---|
| Diagnostic radiology | 101 | 22 of 51 | 152% | 49 | 118 | |
| Dermatology | 101 | 24 of 50 | 102% | 44 | 31 | |
| Urology | 92 | 35 of 50 | 150% | 37 | 49 | |
| Ophthalmology | 91 | 35 of 50 | 115% | 42 | 78 | |
| Orthopedic surgery | 92 | 37 of 51 | 129% | 39 | 89 | |
| Internal medicine | 86 | 38 of 51 | 102% | 25 | 114 | |
| Cardiology | 88 | 41 of 51 | 123% | 38 | 80 | |
| Gastroenterology | 86 | 44 of 50 | 169% | 36 | 49 |
Specialty by payer in West Virginia
| Specialty | UHC | Aetna | Cigna | BCBS |
|---|---|---|---|---|
| Internal medicine | 113 | 65 | 88 | 74 |
| Dermatology | 126 | 72 | 133 | n/a |
| Ophthalmology | 129 | 80 | 90 | 88 |
| Cardiology | 96 | 69 | 95 | 77 |
| Orthopedic surgery | 123 | 71 | 103 | 69 |
| Diagnostic radiology | 149 | 77 | 136 | 72 |
| Urology | 112 | 66 | 100 | 76 |
| Gastroenterology | 115 | 66 | 85 | 62 |
West Virginia compared with South region states
| State | Index | Rank | % of Medicare | Providers | Level |
|---|---|---|---|---|---|
| West Virginia | 93 | 34 | 146% | 608 | |
| Arkansas | 93 | 36 | 144% | 788 | |
| South Carolina | 92 | 38 | 140% | 872 | |
| Virginia | 91 | 39 | 139% | 907 | |
| Tennessee | 96 | 29 | 143% | 944 | |
| Louisiana | 89 | 41 | 132% | 917 |
Procedures that pay most and least in West Virginia vs the nation
Highest vs national
| Code | West Virgini | National | Gap | Prov. |
|---|---|---|---|---|
| 11104 Punch bx skin single lesion | $107 | $81 | +32% | 31 |
| 11102 Tangntl bx skin single les | $85 | $65 | +32% | 31 |
| 93298 Rem interrog dev eval scrms | $69 | $52 | +32% | 80 |
| 64566 Neuroeltrd stim post tibial | $82 | $69 | +18% | 48 |
| 93297 Rem interrog dev eval icpms | $61 | $52 | +16% | 80 |
| 13152 Cmplx rpr e/n/e/l 2.6-7.5 cm | $571 | $498 | +15% | 31 |
| 17004 Destroy premal lesions 15/> | $175 | $154 | +14% | 31 |
| 67042 Vit for macular hole | $1,704 | $1,494 | +14% | 76 |
| 17313 Mohs 1 stage t/a/l | $582 | $515 | +13% | 31 |
| 71045 X-ray exam chest 1 view | $37 | $33 | +13% | 116 |
| 67210 Treatment of retinal lesion | $739 | $659 | +12% | 76 |
| 67108 Repair detached retina | $1,775 | $1,594 | +11% | 76 |
| 13121 Cmplx rpr s/a/l 2.6-7.5 cm | $440 | $398 | +11% | 31 |
| 74174 Cta abd&plvs w/contrast | $666 | $601 | +11% | 117 |
| 51700 Irrigation of bladder | $85 | $77 | +10% | 48 |
Lowest vs national
| Code | West Virgini | National | Gap | Prov. |
|---|---|---|---|---|
| 88342 Imhchem/imcytchm 1st antb | $68 | $95 | -28% | 31 |
| 43251 Egd remove lesion snare | $328 | $425 | -23% | 49 |
| 26055 Incise finger tendon sheath | $477 | $614 | -22% | 89 |
| 93925 Lower extremity study | $274 | $349 | -21% | 78 |
| 93229 Remote 30 day ecg tech supp | $866 | $1,088 | -20% | 79 |
| 43248 Egd guide wire insertion | $293 | $364 | -20% | 49 |
| 75574 Ct angio hrt w/3d image | $402 | $495 | -19% | 78 |
| 43255 Egd control bleeding any | $372 | $459 | -19% | 49 |
| 96372 Ther/proph/diag inj sc/im | $20 | $24 | -19% | 114 |
| 45378 Diagnostic colonoscopy | $332 | $408 | -19% | 49 |
| 46221 Ligation of hemorrhoid(s) | $283 | $346 | -18% | 49 |
| 93880 Extracranial bilat study | $234 | $283 | -17% | 309 |
| 92012 Intrm oph exam est patient | $63 | $76 | -17% | 78 |
| 55866 Laps surg prst8ect rpbic rad | $1,865 | $2,237 | -17% | 49 |
| 45385 Colonoscopy w/lesion removal | $458 | $549 | -16% | 163 |
Frequently asked questions
How do commercial reimbursement rates in West Virginia compare with the rest of the country?
West Virginia ranks 34th of 51 states with an index of 93, across 228 procedure codes. Median commercial rates run 146% of the Medicare rate.
Which payer has the highest rates in West Virginia?
In the files we analyzed, UnitedHealthcare has the highest index (130) and Aetna the lowest (76). 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 West Virginia?
Diagnostic radiology ranks 22nd of 51 states.
How many providers does this West Virginia page cover?
608 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 West Virginia and the national median?
CPT 11104 (Punch bx skin single lesion) is highest relative to the nation at 132% of the national median; CPT 88342 (Imhchem/imcytchm 1st antb) is lowest at 72%.
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 West Virginia contracts
Compare your negotiated rates with these state medians by payer and specialty.