CPT 11104 · professional fee

Punch bx skin single lesion (CPT 11104): negotiated rates by payer and state

What UnitedHealthcare, Aetna, Cigna and Blue Cross Blue Shield pay for CPT 11104, from their published in-network rate files.

DermatologySnapshot Aug 2026Professional fee only

National summary

Commercial in-network, four payers combined, professional fee

Median rate

$81

P10 to P90: $45 to $194

vs Medicare

212%

facility rate $38.08

Payer spread

2.77×

UHC $149 vs Aetna $54

State spread

3.9×

AK $188 to AL $48

4,285 sampled providers5,649 TINs51 statesSample-based · how this is calculated

What the data shows

Generated from this code's own numbers

UnitedHealthcare has the highest median for CPT 11104 in the files analyzed, at $149, 177% above Aetna ($54), the lowest of the 4 payers shown.

The state spread is 3.9×: Alaska has the highest median at $188 and Alabama the lowest at $48, a gap larger than the gap between the highest and lowest payer.

Commercial rates run 212% of the Medicare facility rate ($38.08), which ranks 25th of 228 tracked codes by commercial-to-Medicare ratio.

Rates are tightest within Aetna (interquartile range $22) and widest within Blue Cross Blue Shield ($69).

This is a top-25 code for dermatology by Medicare allowed dollars, so it carries real revenue weight for that specialty.

The Medicare comparison uses the facility rate: the non-facility rate ($121.25) is 3.2× higher because it includes device or supply cost that professional-fee contracts do not.

Rates by payer

Median of per-provider median rates, with interquartile range

Payer	Median	P25	P75	vs national	Rank	Providers	Position
UnitedHealthcare	$149	$121	$201	+84%	1	3,596	391% of Medicare
Blue Cross Blue Shield	$74	$54	$122	-9%	2	3,326	194% of Medicare
Cigna	$67	$51	$103	-17%	3	3,447	177% of Medicare
Aetna	$54	$45	$66	-33%	4	3,100	141% of Medicare

Rate distribution

Box = P25 to P75, whiskers = P10 to P90, tick = median, dashed line = Medicare facility ($38.08)

Rates by state

Median across payers · 50 states with enough data

Rank	State	Median	vs national	Highest payer	Lowest payer	Providers
1	Alaska	$188	+132%	Aetna	BCBS	16
2	Hawaii	$164	+103%	UHC	Cigna	41
3	Wisconsin	$150	+86%	UHC	Aetna	99
4	Nebraska	$146	+80%	UHC	BCBS	48
5	Washington	$139	+72%	UHC	Aetna	107
6	Minnesota	$129	+60%	UHC	Aetna	116
7	Mississippi	$122	+51%	BCBS	Cigna	55
8	New Hampshire	$119	+48%	UHC	Aetna	78
9	North Dakota	$119	+48%	n/a	n/a	24
10	Massachusetts	$116	+44%	UHC	Aetna	116
11	New York	$116	+43%	UHC	Aetna	107
12	Connecticut	$113	+40%	UHC	Aetna	109
13	South Dakota	$112	+39%	UHC	BCBS	37
14	Oregon	$112	+39%	UHC	Aetna	108
15	Pennsylvania	$112	+39%	UHC	Aetna	119
16	Maine	$110	+36%	UHC	Aetna	41
17	Vermont	$108	+34%	UHC	Cigna	21
18	North Carolina	$108	+34%	BCBS	Aetna	125
19	West Virginia	$107	+32%	UHC	Aetna	31
20	Iowa	$102	+26%	UHC	Aetna	63
21	California	$96	+19%	UHC	Aetna	97
22	Georgia	$95	+18%	UHC	Aetna	116
23	Ohio	$94	+17%	UHC	Aetna	115
24	Rhode Island	$83	+3%	UHC	Aetna	48
25	Illinois	$80	-1%	UHC	Cigna	113
26	Nevada	$79	-2%	UHC	Aetna	65
27	Delaware	$79	-2%	UHC	Aetna	18
28	Idaho	$77	-5%	UHC	Aetna	46
29	New Mexico	$76	-6%	UHC	Aetna	34
30	Missouri	$75	-7%	UHC	Aetna	118
31	Kansas	$74	-9%	UHC	Aetna	73
32	Montana	$73	-9%	UHC	Cigna	43
32	Utah	$73	-9%	UHC	Aetna	113
34	Tennessee	$71	-12%	UHC	Cigna	122
35	Colorado	$70	-13%	UHC	Aetna	125
36	Kentucky	$70	-13%	UHC	Aetna	112
37	Louisiana	$68	-15%	UHC	Cigna	130
38	New Jersey	$66	-18%	UHC	Aetna	99
39	South Carolina	$66	-18%	BCBS	Aetna	109
40	Texas	$66	-18%	UHC	Aetna	134
41	Arkansas	$63	-22%	UHC	Aetna	65
42	Oklahoma	$63	-22%	UHC	Aetna	80
43	Virginia	$61	-25%	UHC	Cigna	121
44	Indiana	$58	-28%	UHC	Aetna	116
45	District of Columbia	$56	-30%	UHC	Cigna	35
45	Maryland	$56	-30%	UHC	BCBS	109
47	Florida	$56	-31%	UHC	Aetna	113
48	Michigan	$55	-32%	UHC	BCBS	108
49	Arizona	$52	-36%	UHC	BCBS	104
50	Alabama	$48	-41%	UHC	Aetna	131

Frequently asked questions

Answers use this page's data

Which payer has the highest median rate for CPT 11104?

In the files we analyzed, UnitedHealthcare, at a median of $149 across 3,596 sampled providers. Aetna is lowest at $54, 177% lower than the highest.

How does the commercial rate compare with Medicare?

The national median is 212% of the 2026 Medicare facility rate of $38.08.

Which state has the highest median for CPT 11104?

Alaska has the highest median at $188; Alabama has the lowest at $48.

Is this the surgeon, physician or facility payment?

These are professional (physician) fees only. Facility, device and implant payments are priced separately and are not included.

How current is this data?

It is the August 2026 snapshot of each payer's in-network rate file. Sources and filters are listed in the methodology below.

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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