UnitedHealthcare vs Cigna: We Read Both Their Rate Files. One Pays 21% More.

Last week we published what UnitedHealthcare actually pays for an office visit, pulled from the machine-readable files the federal Transparency in Coverage rule requires it to post. The finding was that UnitedHealthcare pays 88% of Medicare for a 99213 and 90% for a 99214, and pays below Medicare for those codes in 35 of 51 states. The fair response to that is a question: compared to what? A number without a peer tells you very little. If every commercial insurer pays around 88% of Medicare for an established patient visit, then that is simply what the commercial market pays and UnitedHealthcare is unremarkable. If nobody else does, that is a different story entirely. So we ran the same extraction against Cigna. Same month, same codes, same office place of service, same method, same verification. This article reports what came back. The short answer is that the truth sits between the two possibilities, and it is more interesting than either.

Comparing payers is easy to do badly, so it is worth stating what we did to keep it honest before showing any numbers. We read both insurers for the <strong>same reporting period</strong>, August 2026. Our earlier UnitedHealthcare figures came from the July files, so we re-downloaded and re-extracted UnitedHealthcare in August rather than compare across months. A month mismatch is the first thing a serious reader would attack, and they would be right. We compare the same <strong>place of service</strong>. Both insurers publish different rates depending on where a service happens, and both differences are large. Every figure below is an office rate. We publish <strong>one flagship national network per insurer</strong>: UnitedHealthcare Choice Plus and Cigna Open Access Plus. Averaging medians across several networks is not a real statistic, and no practice is contracted to an average. We <strong>verified each insurer against its own other networks</strong>. UnitedHealthcare's networks agree with each other on 98% or more of code and state combinations. Cigna's agree on 96% or more. We also re-extracted a UnitedHealthcare network a month apart and got a median ratio of 1.0000, with 62% of figures identical to three decimal places. One difference we cannot method away, and will not hide. The two insurers do not structure place of service identically. UnitedHealthcare's office rates run about 1.4 times its facility rates. Cigna's run about 1.2 times. So UnitedHealthcare draws a sharper line between settings than Cigna does. What follows is a comparison of what each pays in an office, not a claim that they price alike.

Here is the headline, and it is not the one we expected. Cigna pays more than UnitedHealthcare on the established patient visits. It also pays less than Medicare for them. Both things are true at once. That reframes the first article. UnitedHealthcare is not an outlier discounting a code the rest of the market pays fairly. Two of the largest commercial insurers in the country both pay under the federal program rate for the two codes that carry most of the volume in a typical practice, and they differ mainly in how far under. On new patient visits both pay essentially at Medicare. On the joint injection both pay a premium, and there the two diverge sharply.

Look again at the last row. For CPT 20610, a joint or bursa injection, UnitedHealthcare pays a median of $75.21 and Cigna pays $91.22. That is 21% more for pushing the same needle into the same knee. At the state level the gap gets wider. In North Carolina, UnitedHealthcare's median is $69.02 and Cigna's is $102.04, a difference of 48%. In Wisconsin the gap reaches 54%. Out of the 42 states where we hold both insurers for this code, Cigna pays more in all but one. For an orthopedic, rheumatology, sports medicine or pain practice, 20610 is not an incidental code. It is a workhorse. A practice doing 40 of them a month in North Carolina collects roughly $16,000 more a year from the Cigna side of its panel than the UnitedHealthcare side, for identical work, with identical overhead, documented identically. No practice we have ever worked with knew that. It is not knowable from your remits, because your remits only show you what you were paid, never what the payer next to it pays for the same thing.

National medians hide the thing that actually affects your revenue. The two insurers do not sit a consistent distance apart. The gap between them is a local phenomenon, and in some markets it is enormous. For a 99213, the single most billed code in American medicine, here is where the two diverge most: North Carolina: UnitedHealthcare $77.61, Cigna $102.41. Cigna pays 32% more. Ohio: UnitedHealthcare $76.51, Cigna $98.20. Cigna pays 28% more. Florida: UnitedHealthcare $75.23, Cigna $94.56. Cigna pays 26% more. A North Carolina primary care practice billing 400 established visits a month sees roughly $119,000 a year of difference between those two rates across its panel. That is not a rounding error and it is not a coding problem. It is a contracting problem that has been invisible until now. One caution on reading state figures. Some cells rest on far fewer observations than others, and a thin cell can produce a dramatic number that means very little. Every figure we publish clears a minimum sample threshold, and each page shows the count behind it. Look at that count before you build an argument on a single state.

Most practices treat payer mix as something that happens to them. You take the contracts available, you serve the patients who walk in, and the mix is whatever it is. These numbers say payer mix is a revenue decision, and a large one. Two practices in the same North Carolina town, same specialty, same coding accuracy, same denial rate, can differ by a fifth in collections purely because one has more Cigna patients and the other more UnitedHealthcare. Nothing either of them does clinically or administratively closes that gap. It is set at the contract, and until the transparency files existed there was no way to see it. Three practical consequences. When you evaluate a new contract, you now have a market benchmark rather than the payer's assurance that its offer is standard for your area. That claim is checkable. When you plan capacity, the codes you can serve more of are not all worth the same. A slot filled with a Cigna joint injection is worth meaningfully more than the same slot filled from the other panel. And when you renegotiate, the strongest argument is no longer that you deserve more. It is that a named competitor is already paying more for the same code in the same state, published by that competitor, and you brought the number.

We would rather draw the limits ourselves than have someone else draw them for us. We are not saying Cigna is the better payer. A negotiated rate is one input. Denial rates, days in accounts receivable, prior authorization burden, administrative friction and patient volume all affect what a contract is worth, and none of that lives in these files. An insurer paying 5% more while denying 5% more and paying 30 days slower is not a better contract. We are not saying these are your rates. They are market medians. Half the negotiated rates in a state sit above the figure we publish and half below, and where you fall depends on your group size, your bargaining position, and what you signed. The percentiles on each page exist so you can locate yourself in that spread. We are not saying a rate is a payment. What reaches your bank account depends on eligibility, medical necessity, bundling edits, patient responsibility, and whether the claim survives adjudication at all. And we are not saying two payers describe the market. UnitedHealthcare and Cigna are two of the largest, and Aetna publishes the same files under the same rule. We are working on it. What we are saying is narrow and, we think, solid. For the two codes that carry the most volume in most practices, both of these insurers pay less than Medicare, they pay different amounts, and the difference between them is large enough to matter and local enough that a national average would have hidden it. All of it comes from documents the insurers published themselves. The full breakdown by code and state is at what payers actually pay, and the method is at our methodology page. If we have something wrong, tell us and we will correct it in public.